Traumatic diaphragmatic rupture

Case contributed by Dr Ian Bickle

Presentation

Passenger in high speed RTA on a motorway. Distended abdomen. Back pain.

Patient Data

Age: 40 years
Gender: Male

CT CHEST

7cm fluid-air filled cavity at the left base in continuity with the stomach which extends through a 1.6cm defect in the left hemi-diaphragm.

Tiny anterobasal left pneumothorax, measuring 8mm in depth.  Left basal consolidation presumed contusional.

Fractures of the left 3-8th ribs, prodominently posteriorly in the paramidline.

CT ABDOMEN

Solid organs normal.

No free gas or fluid.

The patient proceeded to an emergency laparotomy, which identified a 2cm defect in the left hemi-diaphragm through which a 5cm segment of stomach was protruding.  The defect was surgically closed.

Case Discussion

Diaphragmatic rupture often results from blunt abdominal trauma, which is usually associated with motor-vehicle accidents as in this case.

The rupture occurs due to increased intra-abdominal pressure from forceful impact.

An hour-glass (or collar) appearance is present due to the stomach herniating through a small defect in the diaphragm comparative to the amount of stomach either side of the diaphragm.

If left uncorrected ischemia may occur.  Prompt surgical correction as in this case is necessary.

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