Surgical Outcomes of Right Traumatic Diaphragmatic Rupture with Grade 3 Liver Injury: A Report of 2 Cases

BACKGROUND Traumatic diaphragmatic rupture (TDR) is a rare entity. Its diagnosis can be challenging due to its nonspecific clinical presentation. Therefore, diagnosis is often late or missed. This article presents 2 cases of right-sided TDR accompanied by intrathoracic herniation of the liver. CASE REPORT Case 1: A 42-year-old male construction worker sustained an injury caused by a falling metallic frame. Upon presentation, he had a paradoxical breathing pattern. The initial chest radiograph showed multiple right-sided rib fractures and pneumohemothorax drained by a thoracostomy tube. A computed tomography scan (CT scan) showed right hemi-diaphragmatic rupture accompanied by intrathoracic herniation of the liver and grade 3 liver injury. Case 2: A 22-year-old man sustained a crush injury. A chest X-ray (CXR) delineated a loop of bowel within the right hemithorax. A CT scan confirmed the diagnosis of right hemi-diaphragmatic rupture with herniation of the right hepatic lobe, hepatic flexure of colon into the right hemithorax, and grade 3 liver injury. Both patients underwent successful immediate emergency laparotomy and primary repair of the diaphragmatic injury. CONCLUSIONS TDR is a rare trauma entity that is difficult to recognize clinically and radiologically. Accurate diagnosis is crucial to establish the appropriate and immediate surgical management plan.