Colonic perforation secondary to post traumatic diaphragmatic hernia: a case report

Abstract

Post traumatic diaphragmatic hernia (PTDH) is a rare cause of large bowel obstruction, and can present weeks or years after the initial trauma. We report the case of a 42 years old male adult who presented in emergency with features of acute generalised peritonitis secondary to closed loop obstruction. Patient had history of fall leading to blunt trauma chest 9 months back which was managed with Intercostal drainage (ICD) left chest at that time. Chest radiography showed multiple air-fluid levels in the left upper quadrant, an air-fluid level in the left thoracic cavity and significant free air under the right side of diaphragm. On laparotomy there was feculent material in abdominal cavity, dilated caecum, ascending colon, transverse colon with invagination of splenic flexure of colon into thoracic cavity. A segment of transverse colon was gangrenous and there was a perforation of size 2 x 2 cm present. Right hemicolectomy performed and loop ileostomy along with DMF transverse colon fashioned in emergency setting. Diaphragmatic hernia repaired after 3 months. Posttraumatic diaphragmatic hernias should be part of the differential diagnosis for patients with bowel obstruction, especially if there is a history of trauma. Radiography is useful in facilitating a quick diagnosis. When patients present complications, there is a higher rate of morbidity and mortality (31%) therefore emergency surgery is mandatory.