Delayed Traumatic Diaphragmatic Hernia With Bacterial Pleuritis

Abstract

Thoraco-abdominal blunt trauma may cause traumatic diaphragmatic hernia. Here, we report a case of delayed traumatic diaphragmatic rupture with herniation of multiple viscera along with bacterial pleuritis without perforation or necrosis. A 72-year-old man presented with severe left-sided chest pain and dyspnea following a fall in the bathroom on the previous day; he had hit the left side and back of the chest against a faucet. Computed tomography (CT) revealed pneumoderma, mediastinal emphysema, pneumothorax, and fractures of the 8th–11th left ribs. We diagnosed traumatic pneumothorax, which was treated by a thoracostomy tube inserted into the pleural space. Approximately 6 months later, he presented again with fever (39.2°C), dyspnea, and coughing. The white blood cell count and C-reactive protein were elevated at 20.3 × 103/μL and 28.7 mg/dL, respectively. A CT scan revealed left-sided pleural effusion and diaphragmatic hernia. Thoracocentesis was performed for the pleural effusion, and bacterial cultivation tests revealed Bacteroides fragilis; therefore, antibiotics were administered for 3 weeks. Subsequently, diaphragmatic hernia repair was performed. Laparotomy via a left subcostal incision revealed a defect measuring 60 × 60 mm; this was repaired with uninterrupted absorbable sutures without using a hernia mesh to avoid infection. The postoperative course was uneventful, and no recurrence was noted at the 1-year follow-up. We repaired delayed traumatic diaphragmatic rupture with herniation of multiple viscera by simple suturing without using a hernia mesh following the treatment of associated bacterial pleuritis.