A Case of a Diaphragmatic Rupture Complicated With Lacerations of Stomach and Spleen Caused by a Violent Cough Presenting With Mediastinal Shift

Introduction: Diapraghmatic rupture is a clinical case that is mostly seen following a blunt thoracoabdominal trauma or is rarely reported as spontaneously induced by various factors. Clinical Picture: A 28-year-old man presented as an emergency with shortness of breath and severe abdominal pain following a violent cough. His chest radiography and computed tomog- raphy demonstrated left diaphragmatic rupture, mediastinal shift and herniation of gastric fundus into the pleural cavity. Treatment: Left thoracotomy for the replacement of herniated gastric fundus and median laparotomy for the repair of serosal layer of gastric fundus and a diaphragmatic gap were performed. Outcome: He made an uneventful recovery. Conclusions: Diaphragmatic ruptures may be caused by violent coughing with serious life-threatening complications. Ann Acad Med Singapore 2004;33:649-50