Rai Guruprasad, Vishnu Rajkamal, Kumara Vijaya, Kamath Ganesh Sevagur
Department of Cardiovascular Thoracic Surgery, Kasturba Hospital, Manipal Academy of Higher Education, Manipal, India.
Center for Rib Cage Disorders, Department of Cardiothoracic Surgery, SRM Institutes for Medical Science, Vadapalani, Chennai, India.
Trauma Case Rep. 2025 May 27;58:101191. doi: 10.1016/j.tcr.2025.101191. eCollection 2025 Aug.
Traumatic diaphragmatic rupture is an uncommon condition. Furthermore, due to the shielding effect of the liver, right-sided ruptures occur less frequently than left-sided ones.We report two unusual cases of right-sided diaphragmatic rupture due to trauma and describe our experience to aid medical professionals in their diagnosis and management.
This report focuses on two atypical cases of right-sided traumatic diaphragmatic rupture causing herniation of the liver into the right thorax, a rare condition, and this provides insights for healthcare professionals regarding diagnosis and management.
We present two case reports involving male patients aged 64 and 56 who sustained right-sided diaphragmatic ruptures due to blunt trauma mechanisms-a motorcycle accident and a similar road traffic accident, respectively. Clinical examinations and imaging studies revealed hemothorax and elevated right dome of the diaphragm in Case 1 and pneumoperitoneum and multiple fractured ribs with elevated right dome of diaphragm and minimal hemothorax in Case 2. Surgical interventions were conducted for both patients; Case 1 confirmed a right diaphragmatic rupture with liver herniation, which was successfully repaired, and Case 2 surgical intervention revealed a large right-sided diaphragmatic tear, with liver herniating into the thorax. A successful reduction of the liver and closure of the defect were performed.
Diaphragmatic rupture should be considered as a differential in patients involved in any abdominal trauma, specifically on the right side, as the presentation is often subtle. Chest x-ray and computed tomography are essential tools to confirm the diagnosis. Surgical repair of the defect is the standard treatment.
创伤性膈肌破裂是一种罕见的病症。此外，由于肝脏的遮挡作用，右侧膈肌破裂的发生率低于左侧。我们报告两例因创伤导致的右侧膈肌破裂的罕见病例，并描述我们的经验，以帮助医学专业人员进行诊断和治疗。
本报告重点关注两例非典型的右侧创伤性膈肌破裂病例，这种情况会导致肝脏疝入右胸腔，较为罕见，可为医疗保健专业人员提供有关诊断和治疗的见解。
我们呈现两例病例报告，患者分别为64岁和56岁男性，均因钝性创伤机制导致右侧膈肌破裂，分别是摩托车事故和类似的道路交通事故。临床检查和影像学研究显示，病例1有血胸和右侧膈肌穹窿抬高，病例2有气腹、多根肋骨骨折、右侧膈肌穹窿抬高且有少量血胸。两名患者均接受了手术干预；病例1确诊为右侧膈肌破裂伴肝脏疝入，成功修复；病例2的手术干预显示右侧膈肌有一大裂口，肝脏疝入胸腔。成功将肝脏复位并封闭缺损。
对于任何腹部创伤患者，尤其是右侧创伤患者，应考虑膈肌破裂的可能性，因为其表现往往不明显。胸部X线和计算机断层扫描是确诊的重要工具。手术修复缺损是标准治疗方法。
