A CASE OF RIGHT TRAUMATIC DIAPHRAGMATIC HERNIA

We experienced a case of traumatic right diaphragmatic hernia presenting with abrupt onset of ileus symtoms. A 78-year-old man was seen at the hospital because of adrupt onset of abdominal pain. About 10 months before, he had been treated for fracture of the femur due to a traffic accident at the department of orthopedics in our hospital, when no thoracoabdominal trauma was seen and no abnormalities were confirmed on chest simple x-ray test. On admission, an elevation of the right diaphragm and air under it which might be colic air were noted. And the strangulated transverse colon due to enema was observed. With a diagnosis of obstructive phase of traumatic diaphragmatic hernia, an emergent operation was performed. On laparotomy, a defect 3cm in diameter was found at the central tendon of the right diaphragm. Moreover, some part of the transverse colon and greater omentum had moved into cavity without hernia sac. Prolapsed organs were reduced into the abdominal cavity and the ruptured diaphragm was directly closed without resection of the colon. In this case, it is etiologically thought that increased pressure in the abdominal cavity by constipation and enema made the interval phase for 10 months into the obstructive phase.