A CASE OF DIAPHRAGMATIC HERNIA WHICH OCCURRED SIX YEARS AFTER A TRAUMA

We experienced a case of diaphragmatic hernia which occurred six years after a trauma. A 21-year-old woman underwent appendectomy under a diagnosis of acute appendicitis at a nearby hospital 3 days before. However, the patient complained of lasting abdominal pain and vomiting, was found to have a stricture of the large intestine, and was referred to our hospital. On admission tenderness of the epigastric region and weakness in breathing at lower segment of the left lung were recognized. Chest X-ray showed intestinal gas shadow in the left pleural cavity and lifting of left diaphragm.Under a diagnosis of incarceration of diaphragmatic hernia, an emergency operation was performed. Some part of the transverse colon was protruding into the left pleural cavity via the central part of the diaphragmatic tendon and was necrotic. The necrotic part of the colon was resected, and the defect of the diaphragm was sutured directly.As the patient had a history of chest and abdominal contusion by a traffic accident six years ago, she was diagnosed as traumatic diaphragmatic hernia.This case shows us a possibility that a delayed diaphragmatic hernia can occur in a certain period after chest and abdominal trauma.