Revista de Ciencias de la Salud
postoperative day by the pulmonary collapse, after increasing the Hernial content in left
hemithorax.
The formulated hypothesis is that the anterior traumas produced the diaphragmatic lesion that
increased in size, according to the intra-abdominal pressure, of insidious evolution and never
had respiratory symptoms, compensating with the contralateral lung and diverting anatomical
structures to the right. Then, an acute injury would have caused hemodynamic instability or
respiratory failure within the first hours after the traffic accident. Subsequently, after lung
collapse due to the increase in hernia content, the respiratory insufficiency caused
hemodynamic instability, which led to an emergency thoracotomy. After the repair of the defect
in the diaphragm the patient evolved favorably until he received a medical discharge.
It is necessary to take into account the diagnostic possibility of chronic traumatic
diaphragmatic hernia in patients with a record of thoracic traumas, since as it was evidenced in
this case, the patient had factors that caused the acute increase of the hernia content towards
the left hemithorax.
Conclusions
Chronic diaphragmatic hernia, is a rare pathology that can spend much time underdiagnosed
because in most cases it does not cause signs or symptoms that the patient takes into
account. Therefore, the personal record is of vital importance, because with these data the
diagnosis can be focused. People who have suffered chest traumas have a high incidence of
having silent diaphragmatic hernias.
Computed tomography is the diagnostic method of choice, since it also provides the possibility
of detecting associated injuries. On the other hand, the gold standard surgical treatment is
thoracoscopy, to repair the defect in the diaphragm and to reduce the hernial content that is
usually the stomach, except in chronic cases, where open thoracotomy allows greater comfort
to release the hernial content.
Chronic diaphragmatic hernias can have acute complications such as pulmonary collapse or
strangulation of the organ that occupies the hernial sac; these complications must be treated in
an emergent way because they are potentially deadly.
Acknowledgments and Conflicts of Interest
I thank the patient for the total collaboration I requested for the presentation of the clinical case
for educational purposes, and in turn to the Portoviejo Medical Clinic, for their support in the
work I have done, clarifying that I have not received any funding for the writing of the article.
Bibliography
1. Serra, A., Achon, M., Menéndez, D., Carnesoltas, L. Hernia diafragmática postraumática:
caso clínico. Medwave. 2013;13(02).
Qhalikay. Revista de Ciencias de la Salud 3 (2017) 104-113
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