CHSJ

Curr Health Sci J, vol. 52, no. 3, 2026

Posttraumatic Diaphragmatic Hernia Managed by Laparoscopic Repair: Case Report and Review of the Literature

[Case Report]

A. DOBRINESCU(1,2,3), T. BRATILOVEANU(1,2,3), A. MANOLICA(1,2,3), B. MARUNELU(1,2,3), M. ENACHE(1,2), V.M. SURLIN(1,2,3)


(1)1st Surgical Clinic, Emergency Clinical County Hospital of Craiova, Romania;
(2)Emergency Clinical County Hospital of Craiova, Tabaci no. 1, Craiova, Romania;
(3)University of Medicine and Pharmacy of Craiova, Petru Rare? 2-4, Craiova, Romania


Abstract:

Posttraumatic diaphragmatic hernia (PTDH) is an uncommon but potentially life-threatening consequence of blunt or penetrating thoracoabdominal trauma, occurring in an estimated 1-7% of such injuries. Because clinical and radiological signs are frequently subtle or masked by associated injuries, PTDH is missed at initial presentation in up to 30% of cases and may become apparent only months or years later, when herniated abdominal viscera cause obstruction, incarceration or strangulation. We report a 62-year-old woman who, approximately three months after a blunt (crush/rollover) thoracoabdominal trauma, presented with pain at the base of the left hemithorax and dyspnoea; chest imaging demonstrated a left-sided diaphragmatic hernia with intrathoracic herniation of the stomach. The patient underwent laparoscopic repair, with reduction of the herniated stomach and reinforcement of the diaphragmatic defect using a composite mesh (Ventralight). The postoperative course was favourable. We correlate this case with a review of the literature covering the pathophysiology and morphology of diaphragmatic injury, the diagnostic accuracy of available imaging and endoscopic modalities, the American Association for the Surgery of Trauma (AAST) diaphragm injury grading, and current evidence-based operative strategies, including the indications for primary suture versus mesh reinforcement and the technical principles of laparoscopic repair. This case underscores the importance of maintaining a high index of suspicion for diaphragmatic injury based on trauma mechanism alone, and supports laparoscopy as a safe and increasingly preferred approach for both acute and delayed PTDH repair in haemodynamically stable patients.


Keywords: Diaphragmatic hernia, thoracoabdominal trauma, laparoscopic repair, delayed diagnosis, case report



Corresponding: Tudor Bratiloveanu, 1st Surgical Clinic, University of Medicine and Pharmacy of Craiova, Romania; e-mail: tudor.bratiloveanu@umfcv.ro


DOI 10.12865/CHSJ.52.03.15 - Download PDF
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