FECAL STRANGULATION OF RIGHT-SIDED TRAUMATIC DIAPHRAGMATIC HERNIA

Diaphragmatic hernias are not frequent in surgical routine practice. Majority of them occur at the site of the natural openings in diaphragm. Post-traumatic diaphragmatic hernias are uncommon. Left-sided localization of such pathology after a blunt trauma is reported in 95% cases and is attributed to the anatomical features of the intraabdominal organs. Right-sided post-traumatic diaphragmatic hernias are exceedingly rare and are  observed more frequently after an open injury to the chest as compared to a blunt trauma. Right-sided injury to the diaphragm may cause difficulties while making the diagnosis, which may lead to incorrect treatment strategy, and eventually cause severe complications, including lethal outcomes. Recent publications report increased number of undiagnosed injuries to the diaphragm following blunt traumas to the chest and abdomen as well as thoracoabdominal injuries. Even minor ruptures in diaphragm may cause dislocation of the abdominal organs and deterioration of their function. Sporadic publications are dedicated to the strangulated diaphragmatic hernias. The current article presents a case of strangulated right-sided post-traumatic diaphragmatic hernia complicated by the gangrene of the transverse colon in a 62-year old male. The injury to the diaphragm supposedly occurred several months prior to the admission. Right-sided post-traumatic diaphragmatic hernia caused minor symptoms and was not diagnosed during pre-hospital management at an outpatient medical office. A repeated trauma to the chest caused difficulties in passage of the chyme through the hernia and lead to the ischemia and necrosis with subsequent perforation of the colon. Strangulation occurred after 10 days following a repeated blunt trauma to the chest and the abdomen; the final diagnosis was made several days after the trauma, which may be explained by the absence of specific clinical symptoms. Despite the prolonged time period between the onset of the disease and surgical treatment, followed by the development of complications, the patient achieved a recovery. Rare incidence of the right-sided post-traumatic diaphragmatic hernias necessitates a more thorough physical and instrumental examination of the patients admitted to the hospital after blunt trauma to the chest or the abdomen. Computed tomography is highly informative in detecting rightsided post-traumatic diaphragmatic hernias. Surgical access is chosen individually. Rightsided thoracotomy and laparotomy used in the given case allowed to perform an adequate operative procedure with satisfactory results.