Abstract :
We report a case of delayed presentation of diaphragmatic rupture following 2 weeks of motorcycle acci-
dent. A 31 year old woman presented with nausea, vomiting, upper abdominal pain and respiratory distress. Chest
radiography showed “double bubble” gas in the left hemithorax with marked mediastinal shift to the right. The
diagnosis of diaphragmatic rupture was suspected and she underwent thoracotomy. There was tearing of the left
diaphragm parallel to the costal insertion measuring 8 centimeters with herniation of the whole stomach, spleen and
transverse colon into the left chest. The hernia was reduced and the left diaphragm was repaired. She started to
improve after surgery and was discharged on day 9. It was suspected that the initial tear of the diaphragm was small
and unrecognized. It probably enlarged with time and active vomiting. Diaphragmatic rupture may be caused by
blunt abdominal injury and a high index of suspicion with early surgical treatment is the mainstay of successful
management.
Key words : Diaphragmatic rupture, abdominal injury
[Thai J Gastroenterol 2004; 5(1):76-78]
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file/Thai-Journal-of-gastroenterology-vol-5-no-1-2618281.pdf