Document Type : Case Report
Authors
1 Trauma Surgery Department, All India Institute of Medical Sciences Patna Bihar India
2 Trauma Surgery, All India Institute Of Medical Sciences Patna , Bihar India
3 Trauma Surgery, All India Institute of Medical Sciences Patna , Patna, India
4 General Surgery, All India Institute of medical sciences Patna, Patna India
5 Trauma Surgery, All India institute of Medical sciences, Patna, India
6 Trauma Surgery, AIIMS Patna , Patna, Bihar INDIA 801507
Abstract
Objective:
Diaphragmatic eventration (DE) is a rare condition that can mimic traumatic diaphragmatic hernia, particularly in trauma cases. We report a case of DE initially misdiagnosed as diaphragmatic hernia following a road traffic accident, emphasizing diagnostic challenges and surgical management.
Case Presentation:
A 50-year-old male presented after a road traffic accident with chest discomfort and decreased air entry on the left side. Chest X-ray showed left para-cardiac opacity, and contrast-enhanced CT (CECT) thorax suggested a central diaphragmatic defect with herniation of the transverse colon and mesocolon. Exploratory laparotomy revealed no diaphragmatic rupture but a central eventration measuring 10×5×7 cm containing bowel loops. The contents were reduced, and diaphragmatic plication with non-absorbable polypropylene sutures was performed. Postoperative recovery was uneventful, and the patient was discharged on day eight. At follow-up, he remained asymptomatic.
Discussion:
DE, described as early as 1774, results from diaphragmatic muscle being replaced by fibroelastic tissue. Differentiating DE from hernia is difficult in trauma, as both may present with reduced breath sounds and abnormal radiographic findings. Even advanced imaging such as CECT may not reliably distinguish them. In this case, chest trauma history and imaging favored hernia, but surgery confirmed DE. Plication is the standard treatment for symptomatic DE, restoring diaphragm function and preventing visceral herniation.
Conclusion:
This case underscores the importance of considering DE in trauma patients. Surgical exploration remains vital for definitive diagnosis, and plication offers effective, durable management.
Keywords
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