Diagnostic Laparoscopy for Right Hemidiaphragm Rupture With Laparotomy Repair: A Case Report

Abstract

Post-traumatic hemidiaphragm rupture is a rare occurrence with a high mortality rate. The gold standard for diagnosis is exploratory laparotomy, which itself carries a high mortality rate in the emergent setting, as is commonly the case following blunt or penetrating abdominopelvic trauma. In this case, a 31-year-old patient with no significant medical history, who presented following an automobile accident with shoulder and gluteal pain with negative radiologic findings, was discussed. The goal of this case was to increase awareness of a possible alternative to the exploratory laparotomy for hemidiaphragm rupture in the emergent setting associated with lower mortality due to the operation. In this case, diagnostic laparoscopy was performed, and right hemidiaphragm was diagnosed. Repair was made via laparotomy with incorporation of the laparoscopic port incisions into the laparotomy incision. Repair was made using 2-0 interrupted non-absorbable sutures with both the anterior and posterior flaps of the hemidiaphragm supported with large pledgets. The patient tolerated the operation well, and has since recovered completely. This case demonstrates the possibility of utilizing minimally invasive techniques for the diagnosis of isolated diaphragm injury. Additionally, this case highlights the inadequacies of modern imaging technologies for the diagnosis of diaphragm injury, and supports the need of improvement in this technology or an alternative modality with increased sensitivity to rule out diaphragmatic injury.




J Curr Surg. 2016;6(1):33-36
doi: http://dx.doi.org/10.14740/jcs298w