A CASE OF TRAUMATIC DIAPHRAGMATIC HERNIA DESIGNATED AS THE PHASE OF OBSTRUCTION DUE TO AN ACCIDENT 30 YEARS PREVIOUSLY

This paper reports a case of traumatic diaphragmatic hernia, presenting with intestinal obstruction, which occurred 30 years after an accident. An 89-year-old woman referred to the hospital because of abdominal distension, vomiting and dyspnea. There was a previous history of meeting with an accident at a coal mine 30 years before when she had chest contusion and a rib fracture. Chest X-ray showed an intestinal gas shadow in the left lung field. On laparotomy, there was a defect of 10cm in diameter at the central tendon of the left diaphragm. And the stomach, small intestine and transverse colon were escaped into the thoratic cavity. The defect was repaired with direct suture. From the previous history of trauma, the location of the defect, and the lack of the hernia sac, the patient was diagnosed as obstructive phase of traumatic diaphragmatic hernia. It is considered that a laparotomy is preferable as the first acsess in obstructive phase.