A case report on Delayed Presentation of Traumatic Diaphragmatic Hernia

Abstract

Aims: This case report highlights traumatic diaphragmatic hernias, their delayed presentations, and successful laparoscopic repair. Case Presentation: We report a 36-year-old man with delayed presentation of TDH, 18 months after blunt thoraco-abdominal trauma. He presented with acute intestinal obstruction. Imaging revealed a 30 × 30 mm left diaphragmatic defect with herniation of the splenic flexure and omentum, complicated by obstruction and perforation. Laparoscopic exploration demonstrated a 3.5-cm defect with ischaemic colon and two perforations. The defect was repaired with non-absorbable sutures, and the ischaemic colon was resected with creation of a double-barrel colostomy. The postoperative course was uneventful, and the patient was discharged with a planned colostomy closure done at 8 weeks. Discussion: Traumatic diaphragmatic hernia (TDH) in adults is uncommon and often under-diagnosed, with delayed presentations posing a significant risk of morbidity and mortality. Early surgical repair is advocated in most cases. Primary repair of the defect is sufficient, and in select cases, a mesh repair is preferred. With the advent of minimal access surgery, laparoscopic repairs are now the standard of care. Conclusion: In stable patients, laparoscopic repair of TDH is a safe and effective approach, combining diagnostic accuracy with therapeutic benefit. Early recognition and intervention are crucial to prevent complications.