Diaphragmatic injury post blunt trauma precipitating a year later as tension fecopneumothorax and left liver lobe herniation: Lesson to learn

Abstract

Bowel perforation leading to feco-pneumothorax is rare yet serious acute emergency with poor prognosis, requiring urgent surgical intervention and often intensive postoperative care. Worldwide, there are a handful of case reports of missed post traumatic diaphragmatic hernia of which feco-pneumothorax as presentation is even rarer. Here, we report a case of 38 years old male who following RTA one year ago developed left side hemopneumothorax with 4th–6th rib fracture with right shaft of femur fracture, which was managed by left ICD, open reduction with internal fixation of shaft of femur, antibiotics & analgesics. He was then discharged after uneventful hospitalization. Patient was asymptomatic in interim until one day, he presented to emergency and diagnosed with feco-pneumothorax due to perforation of herniated bowel along with herniation of falciform ligament and segment of left liver lobe through an anteromedial diaphragmatic rent.