We report a case of a 78-year-old woman allergic to cefuroxime and with a history of hearing loss, osteoporosis, hiatal hernia and neuropatic pain secondary to multiple trauma by traffic accident.
She came to the emergency department with diffuse abdominal pain of 2 days duration accompanied by nausea, vomiting and dysthermic sensation.
Physical examination revealed abdominal pain upon palpation in the left hypochondrium with generalized defense, without peritonitis and marked hypoventilation in the left hemithorax.
Urgent blood tests were performed, highlighting a marked leukocytosis with deviation to the left and a chest and abdominal X-ray in which the presence of loops of the small intestine with diaphragmatic hydrothorax levels occupying a hernia.
With this radiological result it was decided to complete the study by means of a CT confirming the presence of small intestine and fat mass in left hemithorax without signs of complication.
After diagnosis, delayed emergency surgery was performed.
Median approach of the abdominal cavity by supraumbilical midline laparotomy, we observed a defect of the entire left hemidiaphragm, and we could see the heart without pericardium supported by the intestinal package.
The hernia content (mainly small bowel loops and large omentum) is reduced to the abdominal cavity after checking intestinal viability allowing expansion of the collapsed left lung.
Closure of the pericardium with loose silk stitches of no 00. and simple closure of the left hemidiaphragm with no 2 silk.
The patient evolved favorably during the postoperative period.
Hospital discharge occurred 13 days after surgery.
1.
In the particular case of this patient, diaphragmatic hernia was secondary to high-energy polytrauma with late onset clinical manifestations.
