Traumatic right diaphragmatic hernia in an elderly patient. A rare case report

Abstract

Introduction: Diaphragmatic hernia arises as a result of the movement of the abdominal organs towards the thorax through a defect in the diaphragm resulting from various types of injuries, which often represent a diagnostic and therapeutic challenge. Traumatic diaphragmatic hernia is a rare disease. Diaphragmatic trauma is rarely isolated, most of the time it is accompanied by other thoracoabdominal, brain or musculoskeletal injuries, these more serious comorbidities being responsible for the poor prognosis and increased mortality. Clinical case: A 90-year-old woman with hypertension , who began a clinical picture 48 hours prior to admission, when after falling from the standing plane he presented a decreased state of consciousness, nausea, vomiting, and dyspnea at rest. Chest x-ray shows intestinal loops in the right hemithorax. Exploratory laparotomy is performed. Conclusion: Traumatic diaphragmatic hernias are rare (3% incidence), non-specific symptoms and related to injuries associated with trauma. HD should always be suspected when encountering a patient with a history of high-impact or penetrating blunt trauma, based on the kinetics and mechanism of injury. Diagnosis is a challenge for the surgeon, and must be based on a firm suspicion and radiological studies. Its treatment is surgical, It must be individualized, with thoracic or abdominal approaches depending on the case. The technique to be used will depend on the characteristics of the defect and the stage of diagnosis.