Abstract
Introduction
Traumatic diaphragmatic rupture is a relatively uncommon occurrence, with an incidence of 0.8–5% reported in the literature. The reported percentage of missed diaphragmatic injuries that were discovered later ranges from 12 to 66%. Herniation of the liver through the right diaphragm has been reported in the literature after liver transplantation, and in trauma populations.
Materials and methods
Here, we report a case of late identification of partial liver herniation into the right chest (8 years post initial injury), due to a recent motor vehicle crash. Thought to be suffering from an acute injury, the patient was taken to the operating room and a laparoscopically assisted mini-thoracotomy was performed. An old diaphragmatic injury was found intraoperatively; laparoscopically assisted mini-thoracotomy was used to repair the diaphragm, and the liver was returned into the abdomen.
Conclusion
Right-sided diaphragmatic laceration, if diagnosed at the time of injury, may be repaired with the minimally invasive technique we describe here.
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References
Rosetti G, Brusciano L, Maffetone V, Napolitano V, Sciaudone G, DelGenio G, Russo G, Del Genio A. Giant right post-traumatic diaphragmatic hernia: laparoscopic repair without a mesh. Chir Ital. 2005;52(2):243–6.
Scaglione M, Grassi R, Pinto A, Ragozzino A, Romano S, Pinto F. Delayed presentation of traumatic left-sided diaphragmatic avulsion. A case report. Acta Radiol. 2000;41:165–6.
Killeen KL, Mirvis SE, Shanmuganathan K. Helical CT of diaphragmatic rupture caused by blunt trauma. AJR Am J Roetgenol. 1999;173:1611–6.
Eren S, Kantarci M, Okur A. Imaging of diaphragmatic rupture after trauma. Clin Radiology. 2006;61:467–77.
Chen HW, Wong YC, Wang LJ, Fu CJ, Fang JF, Lin BC. Computed tomography in left-sided and right-sided blunt diaphragmatic rupture: experience with 43 patients. Clin Radiol. 2010;65:206–12.
Ivatury RR. Laparoscopy and thoracoscopy in penetrating thoracoabdominal injuries. Eur Surg. 2005;37:19–27.
Powell BS, Magnotti LJ, Schroeppel TJ, et al. Diagnostic laparoscopy for the evaluation of occult diaphragmatic injury following penetrating thoracoabdominal trauma. Injury. 2008;39(5):530–5.
Murray JA, Demetriades D, Cornwell EE, et al. Penetrating left thoraco-abdominal trauma, the incidence and clinical presentation of diaphragmatic injuries. J Trauma. 1997;43:624–6.
Wagner D, Iberer F, Sereinigg M, Kniepeiss D, Kornprat P, Fahrleitner-Pammer A, Stiegler P, Tscheliessnigg K. Massive diaphragmatic herniation following orthotopic liver transplantation in an adult. Liver Transpl. 2010;16(6):783–5.
Amini A, Latifi R. Laparoscopic-assisted management of thoracoabdominal penetrating trauma: a novel approach (oral presentation). In: 11th Congr European Trauma and Emergency Society, Brussels, Belgium, 16–19 May 2010.
De Rezende Neto JB, Guimaraes TN, Madureira JL Jr, Drumond DAF, Leal JC, Rocha A Jr, Oliveira RG, Rizoli SB. Non-operative management of right side thoracoabdominal penetrating injuries–the value of testing chest tube effluent for bile. Injury. 2009;40(5):506–10.
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Diven, C., Latifi, R. Partial liver herniation into the right chest following trauma: a delayed presentation as acute injury managed by laparoscopically assisted mini-thoracotomy. Eur J Trauma Emerg Surg 37, 665–668 (2011). https://doi.org/10.1007/s00068-011-0153-y
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DOI: https://doi.org/10.1007/s00068-011-0153-y