Traumatic Left Diaphragmatic Rupture with Intrathoracic Gastric Herniation and Concomitant Bladder Injury After Blunt Thoracoabdominal Trauma: A Case Report and Review of the Literature
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Abstract
Unusual and clinically significant, traumatic diaphragmatic injury (TDI) is a common but seldom reported clinical effect of blunt thoracoabdominal trauma, occurring in about 1-5% of cases and often overlooked on initial assessment. Left-sided ruptures of the gastrointestinal system can herniate abdominal viscera into the thorax and cause strangulation if not performed correctly. We note a left TDI with intrathoracic gastric herniation and a 29-year-old man was admitted to the hospital after a lateral motor vehicle collision with entrapment. He was haemodynamically borderline and had a positive Focused Assessment with Sonography for Trauma (FAST) and peritoneal signs. Contrast-enhanced computed tomography (CT) revealed the left diaphragmatic laceration with the stomach herniated into the left hemithorax, left lung atelectasis and a bladder injury in a similar fashion to the one reported in the case of a recent ER. He underwent exploratory laparotomy, reduction of the stomach, primary diaphragmatic repair (phrenorrhaphy) with non-absorbable suture and left chest tube placement. The intraperitoneal survey showed a non-perforating gastric contusion and a bladder-wall haematoma without leak.
TDI diagnosis is based on suspicion and CT, as plain radiography is not sensitive to it. In acute cases, the abdominal approach is preferred as this allows for reduction of herniated viscera and treatment of resultant injuries. Extraperitoneal bladder injuries are generally treated conservatively via catheter drainage, whereas intraperitoneal ruptures are repaired. Prompt CT recognition and an abdominal-first approach allowed for the single-stage repair of a left TDI with intrathoracic gastric herniation and conservative treatment of a low-grade bladder injury, and a non-eventful recovery and discharge. This work is reported in accordance with the SCARE 2020 criteria.
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