Huge post-traumatic diaphragmatic hernia remained asymptomatic for 14 years. A case report

  • Serafeim Chlapoutakis
  • Vassileios Vassileiadis
Case report


A 27-year-old male had an abdominal violation in a prison 14 years before the display of his symptoms and was misdiagnosed as massive haemothorax. The patient remained asymptomatic for 14 years and his symptoms were only a mild dyspnoea and mild dysphagia. This patient had a huge chronic postdiaphragmatic hernia with most of the abdominal organs in the left hemithorax. A left thoracotomy was performed and a mesh was used to close the huge posttraumatic diaphragmatic hernia (diameter of 15 cm), after repositioning the abdominal organs. The left lung was completely consolidated and required dissection of multiple adhesions and high pressure manual ventilation to reexpand normally. Blunt post-traumatic diaphragmatic ruptures may be misdiagnosed and become chronic asymptomatic hernias for several years. Once they become symptomatic, they have to be treated as soon as possible as major organ injuries may be hidden.


Traumatic diaphragmatic hernia Diaphragmatic rupture Dyspnoea 



We would like to thank Mr. Iraklis Katsoulis, a general surgeon of our hospital, for his consultation and his help with this case.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The procedure performed in studies involving human participants was in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from the patient included in the study.

Supplementary material

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  1. 1.
    Ward RE, Flynn TC, Clark WP. Diaphragmatic disruption secondary to blunt abdominal trauma. J Trauma. 1981;21:35–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Shah R, Sabanathan S, Mearns AJ, Choudhury AK. Traumatic rupture of diaphragm. Ann Thorac Surg. 1995;60:1444–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Kuo IM, Liao CH, Hsin MC, et al. Blunt diaphragmatic rupture—a rare but challenging entity in thoracoabdominal trauma. Am J Emerg Med. 2012;30:919–24.Google Scholar
  4. 4.
    Feliciano DV, Cruse PA, Mattox KL, et al. Delayed diagnosis of injuries to the diaphragm after penetrating wounds. J Trauma. 1988;28:1135–44.CrossRefPubMedGoogle Scholar
  5. 5.
    Hanna WC, Ferri LE, Fata P, Razek T, Mulder DS. The current status of traumatic diaphragmatic injury: lessons learned from 105 patients over 13 years. Ann Thorac Surg. 2008;85:1044–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Fair KA, Gordon NT, Barbosa RR, Rowell SE, Watters JM, Schreiber MA. Traumatic diaphragmatic injury in the American College of Surgeons National Trauma Data Bank: a new examination of a rare diagnosis. Am J Surg. 2015;209:864–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Ties JS, Peschman JR, Moreno A, et al. Evolution in the management of traumatic diaphragmatic injuries: a multicenter review. J Trauma Acute Care Surg. 2014;76:1024–8.Google Scholar
  8. 8.
    Mansour KA. Trauma to the diaphragm. Chest Surg Clin N Am. 1997;7:373–83.PubMedGoogle Scholar
  9. 9.
    Rosati C. Acute traumatic injury of the diaphragm. Chest Surg Clin N Am. 1998;8:371–9.PubMedGoogle Scholar
  10. 10.
    Scharff JR, Naunheim KS. Traumatic diaphragmatic injuries. Thorac Surg Clin. 2007;17:81–5.CrossRefPubMedGoogle Scholar

Copyright information

© Indian Association of Cardiovascular-Thoracic Surgeons 2018

Authors and Affiliations

  • Serafeim Chlapoutakis
    • 1
  • Vassileios Vassileiadis
    • 1
  1. 1.Thoracic Surgery Department in «Agios Savvas»Anticancer Oncological Hospital of Athens-GreeceAthensGreece

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