Acute right heart failure revealing delayed traumatic right-sided diaphragmatic hernia: Case report and literature review.

Abstract

Diaphragmatic hernia is a rare post-traumatic complication of high-intensity trauma . Generally localized on the left side, right-sided localization is rarer, and may be undiagnosed in the acute phase of trauma.. We report the case of a 26-year-old patient, with a history of abdominal trauma 3 weeks previously, admitted to the emergency department for acute right heart failure signs, in whom a thoracoabdominal CT scan was performed, showing massive herniation of the right lobe of the liver intra-thoracically through a right diaphragmatic hernia, with compression of the right cardiac chambers responsible for hemodynamic collapse. Diaphragmatic hernia (DH) can occur congenitally or as a result of trauma. Traumatic diaphragmatic hernia (TDH) accounts for approximately 1%-7% of major trauma cases and is often associated with high-impact injuries. TDH is caused when a blunt or penetrating trauma ruptures the diaphragm, allowing the abdominal organs to herniate into the thoracic cavity. Symptoms of TDH can differ considerably depending on the degree of herniation and associated lesions. Imaging is crucial to the diagnosis of TDH, with chest X-ray often the first imaging modality used. Findings may include elevation of the hemidiaphragm, abnormal gas in the chest or the presence of abdominal organs in the thoracic cavity. Management of TDH begins with an initial assessment and stabilization of the patient, in accordance with the advanced trauma life support (ATLS) protocol. In patients with respiratory distress, hemodynamic instability, signs of strangulation or intestinal ischemia, immediate surgical intervention is warranted, and is often performed by laparotomy or thoracotomy.