Case Report: Traumatic Diaphragmatic Hernia with Intrapericardial Herniation of the Transverse Colon

importance of increased vigilance and knowledge of this condition among providers of trauma care.Written informed consent to submit this case report was obtained from the patient. Case DesCriptionA 44-year-old male presented to our level I trauma center after a 40 feet fall.The patient was initially hemodynamically stable with introDuCtion Traumatic diaphragmatic hernia (TDH) is a rare and potentially life-threatening consequence of blunt or penetrating trauma, complicating fewer than 1% of all trauma cases. 1 In blunt trauma, a sudden increase in the pleuroperitoneal pressure gradient which exceeds the diaphragm's tensile strength results in rupture of the diaphragm.This occurs most commonly on the left side due to the liver's protective position under the right side of the diaphragm.Diagnosis of TDH may be challenging due to nonspecific cardiorespiratory and gastrointestinal symptoms. 2Delayed diagnosis and thus delayed treatment is common, occasionally unrecognized for months or years posttrauma.Imaging modalities such as chest radiography, ultrasonography, MRI, and CT may be used to diagnose TDH; however, recognition of subsets such as traumatic hernia through the central tendon can be particularly difficult due to its rarity and atypical presentation.Additionally, given the orientation of the scanner gantry to the relatively thin diaphragm muscle, small defects in the diaphragm may go unnoticed on initial imaging. 3ompounding this diagnostic difficulty is the fact that organs do not typically herniate through small defects that are created acutely, but herniate later after days to weeks of diaphragmatic muscle excursion lead to widening of the initial defect.We present the diagnostic workup and surgical management of traumatic hernia through the central tendon of the diaphragm in a 44-year-old male who fell 40 feet from construction scaffolding.