[Symptomatic enterothorax in right-sided dorsal rupture of the diaphragm].

Abstract

Traumatic avulsion of the right diaphragm from the lumbocostal arch is a very rare lesion. The authours report the case of a 27-year-old man who had suffered a severe polytrauma with blunt thoracic injury, fracture of the lumbar spine, Malgaigne-type fracture of the pelvis and fracture of the femoral shaft on the right side, 10 years before. At the time of injury the lesion of the diaphragm went unnoticed. The diagnosis was made 10 years later when the patient was referred for chronic right thoracic pain combined with postprandial abdominal distension and crampy pain in the abdomen. The chest radiogram and CT-scan showed displacement of the right kidney and most of the right colon into the thorax due to avulsion of the diaphragm from its dorsal insertion on the lumbocostal arch. Surgical repair was necessary to obtain relief from pain and to prevent intestinal obstruction. Reduction of the hernia, reinsertion of the diaphragm to the lumbocostal arch and reinforcement of the repair with a prolene mesh prosthesis was performed through a right thoracophrenolumbotomy incision.