Liver incarceration in a post-traumatic diaphragmatic hernia

Background: Diaphragmatic rupture secondary to a thoracoabdominal trauma is an unusual condition. Diagnosis is insidious, being negative at the beginning in almost half of the cases. We present a case of an unusual complication of a right diaphragmatic hernia because of trauma. Material & Methods: A 31-year old male with Background of a car accident 10 years ago, diagnosed of a diaphragmatic hernia by CT in a follow-up for suspected tuberculosis, presenting a thoracic inclusion of the right hepatic lobe through a 5 x 5 cm defect. The patient was asymptomatic. A laparoscopic intervention was schedule, finding a hepatic incarceration requiring conversion to open surgery. We made the reduction of the right hepatic lobe and hernioplasty with a 7,5 x 10 cm Dualmesh PTFE - BARD®, leaving a 20fr endothoracic drainage. The patient was discharged at the 5º day with a Comprehensive Complication Index (CCI) of 8.7 and with no symptoms in 5 years of follow-up. Results and Conclusions: The diaphragmatic rupture after a thoraco-abdominal trauma occurs in 0.8%-5%, ignoring them in 12%-60% during the initial hospital admission. More than 30% manifest as a diaphragmatic hernia of late diagnosis. Around 5% are secondary to traffic accidents, 10% penetrating chest injuries and 0.9%-1.6% blunt thoraco-abdominal trauma. The left side is the most common (3:1 Relation). The late presentation could be explained by a late diaphragm rupture or delayed detection of it. The delayed diagnosis could be explained in 3 phases: first an initial injury (trauma), then a gradual herniation and a third phase of clinical manifestation. In most cases, the presentation is asymptomatic, and the diagnosis of the rupture is incidental during study or a surgical operation due to a different cause. The most common symptoms depend on the affected organ. Surgical treatment in all diaphragmatic rupture is the rule.