Authors: Dr. Syeda Zubaria Qamar, Dr. Syeda Sarah kazmi, Dr. Ahmed Ali, Dr. Syeda Maryam Fatima Zaidi, Dr. Akshay K. Chugh, Dr. Sehrish Alam
ABSTRACT: Introduction: Traumatic diaphragmatic rupture (TDR) is an uncommon consequence of blunt thoracoabdominal trauma, occurring in roughly 0.3–5% of major blunt trauma patients, and is left-sided in the majority of cases because the liver affords the right hemidiaphragm relative protection. Simultaneous herniation of four viscera — stomach, transverse colon, liver, and spleen — through a single left-sided defect is rarely described, since liver herniation is classically associated with right-sided rather than leftsided tears.
Case Presentation: We report a 37-year-old man who sustained a pedestrian-versus-vehicle collision. On arrival at the trauma center he was tachycardic and tachypneic (respiratory rate 36/min). Contrastenhanced CT demonstrated a left hemidiaphragmatic laceration with herniation of the stomach, transverse colon, and portions of the liver and spleen into the left hemithorax, producing ipsilateral lung collapse and contralateral mediastinal shift. He underwent emergency laparotomy with reduction of all herniated viscera and primary repair of the diaphragmatic defect, and tolerated the procedure well with an uneventful early postoperative course.
Conclusion: This case highlights an unusual combination of concurrent gastric, colonic, hepatic, and splenic herniation through a single left diaphragmatic rupture, and underscores the need for a high index of suspicion, prompt cross-sectional imaging, and single-stage surgical reduction and repair in patients with high-energy blunt thoraco-abdominal trauma.
Keywords: diaphragmatic rupture; traumatic diaphragmatic hernia; visceral herniation; blunt trauma; road traffic accident; case report