Gastric Perforation Due to Intercostal Drainage: Is it a Clue to Missed Diaphragmatic Hernia?

Abstract

Acute post-traumatic diaphragmatic hernia often goes unnoticed resulting in unpalatable and disastrous consequences for the patient. There may be a delay between the injury and the diagnosis which can cause a diagnostic dilemma to the surgeon. A patient with a diaphragmatic hernia due to trauma that has long been forgotten often presents with unrelated symptoms and signs. We report a case of delayed presentation of left traumatic diaphragmatic hernia in a 60-year-old male who presented eight months after blunt trauma. An intercostal drain (ICD) was placed in the left hemithorax to drain a pleural effusion which had resulted in gastric perforation containing food particles in the drain bag.  A delay in diagnosis is often the rule in cases of diaphragmatic hernia due to blunt traumas, patients presenting with complications of missed hernia or interventions thereof because of incorrect diagnosis. This case highlights and emphasizes the importance of proper diagnosis in cases of blunt trauma and the astuteness with which history taking and investigations should be pursued before embarking on any therapeutic intervention.