Paediatric Traumatic Diaphragmatic Rupture

Traumatic diaphragmatic rupture is not a common injury in children. It is an important cause of morbidity and mortality, though diagnosis may be missed or delayed with atypical clinical presentation and confounding radiological features. A 4-year-old male presented with periumbilical abdominal pain, bilious vomiting, fever and progressive difficulty in breathing for two days. He had complained of vague left-side chest pain on return from the swimming pool about 6 weeks earlier. An initial chest radiograph showed a non-outlined left hemidiaphragm, a left pneumothorax, rightward mediastinal shift and suspected bowel in the chest. He could not afford a CT scan, hence a repeat chest radiograph was performed, which outlined the stomach with an air-fluid level in the left hemithorax.