Catastrophic traumatic diaphragmatic hernia with subtotal section of the pylorus: case report

Abstract

Traumatic diaphragmatic hernia is an unusual entity in adults that is usually diagnosed late, and is accompanied by high mortality when there is an already existing vascular disorder. The abdominal approach is most frequently used in acute traumatic diaphragmatic hernia and the thoracic approach in chronic traumatic diaphragmatic hernia. We present the clinical case of a female patient who suffered a fall from a height, causing a traumatic diaphragmatic hernia with a subtotal section of the pylorus, leaving the stomach and duodenum practically separated, with a late diagnosis. When the traumatic diaphragmatic hernia causes an intestinal occlusion and there is also a vascular disorder with perforation or sepsis, the mortality is 50 to 80 %. In the event of a trauma that may cause alterations in the thoracic and abdominal cavities, traumatic diaphragmatic hernia should be considered as a possible diagnosis, to prevent complications as a consequence of a late diagnosis.