Blunt Diaphragmatic Rupture Involving the Esophageal Hiatus: Case Report of an Extremely Rare Situation

Acute traumatic diaphragmatic rupture in blunt trauma is a rare entity. The crural extension of a hemidiaphragmatic tear been reported only once. The aim of this study is to report a case of a blunt diaphragmatic rupture involving the esophageal hiatus. Case: A 27-year-old male, a truck driver, was admitted to the emergency department following a violent road traffic accident causing a blunt thoraco-abdomino-pelvic trauma. After stabilization of the patient, a radiological evaluation showed a complex fracture of the pelvis and left clavicle, and a left lung contusion. Seventy-two hours later, the patient presented an uncontrollable vomiting and respiratory distress. A new CTscan revealed a left diaphragmatic rupture. An emergency surgery was performed. After a midline laparotomy, exploration revealed a large central tear of the left hemidiaphragm. The stomach, transverse colon and greater omentum had herniated through the defect into the left hemithorax. The diaphragmatic defect was repaired. During a final exploration of the abdomen, the left triangular and falciform ligaments were divided by electrocautery while caudal traction was placed on the liver. A second rupture involving the esophageal hiatus was identified. It was repaired and the esophageal hiatus reconstructed using interrupted silk sutures. Postoperatively, the patient was managed in the intensive care unit for 4 days. Subsequent recovery was uncomplicated.