Delayed diagnosis of traumatic diaphragmatic rupture with herniation of liver- A case report.

Diaphragmatic rupture is a potential life threatening clinical situation. It occurs as a result of high velocity blunt or penetrating injury to abdomen and thorax. Acute traumatic rupture of diaphragm may go undetected and there is often delay between the injury and diagnosis. Right sided rupture is less common due to hepatic protection and increased strength of right hemidiaphragm. A systematic review of literature by Rashid F et al has revealed 13 cases of right sided diaphragmatic rupture, while herniation of liver occurred only in six cases. We report a case of 28 year old man who was admitted with breathlessness to our hospital 72 hours after trauma. Since clinical signs and symptoms were non-specific, helical computed tomography was done which revealed diaphragmatic rupture with hepatothorax. Emergency thoracotomy was done to repair diaphragmatic rent. Postoperative period was uneventful and patient was discharged from hospital after three weeks.