Right-Sided Diaphragmatic Rupture and Liver Herniation Following Blunt Thoraco-Abdominal Trauma: A Case Report

Post-traumatic diaphragmatic hernias (PTDH) are rare but potentially life-threatening complications of thoraco-abdominal trauma, often underdiagnosed due to their subtle and delayed presentation. This case report describes a 55-year-old female who presented with acute onset of chronic right upper quadrant pain and exertional dyspnea two weeks after sustaining severe blunt thoraco-abdominal trauma in a road traffic accident. Initial evaluation at the time of the trauma revealed no immediate signs of significant injury, and she was discharged without further investigations. On admission, physical examination revealed dullness to percussion and absent breath sounds over the right lower thorax. A thoraco-abdominal CT scan confirmed the diagnosis of a right diaphragmatic hernia, with herniation of the liver into the thoracic cavity through an 8 cm diaphragmatic defect, causing displacement of thoracic structures and compression of the right lung. The patient underwent surgical repair via a midline laparotomy, with reduction of the herniated liver, diaphragmatic defect closure using interrupted non-absorbable sutures, and thoracic drainage. The postoperative course was uneventful, and the patient was discharged on postoperative day 5 with favorable clinical and radiological outcomes at six-month follow-up. This case underscores the diagnostic challenges associated with PTDH, particularly in delayed presentations, and highlights the importance of a high index of suspicion in patients with a history of thoraco-abdominal trauma. Advanced imaging, particularly CT scans, plays a crucial role in diagnosis, while timely surgical intervention is essential for optimal outcomes. The rarity of liver herniation in PTDH further emphasizes the need for increased awareness among clinicians to prevent missed or delayed diagnoses. This report aims to reinforce the importance of thorough clinical evaluation, appropriate imaging, and long-term follow-up in patients with a history of trauma to identify and manage such rare but serious complications.