Laparoscopic Management of Delayed Right Sided Traumatic Diaphragmatic Hernia Presenting with Intestinal Obstruction: A Case Report

Background and Clinical Significance: Traumatic diaphragmatic hernia may remain clinically silent after thoracoabdominal trauma and subsequently present with bowel obstruction. Right-sided defects pose particular diagnostic and operative challenges because of their relationship with the liver. We report delayed right-sided herniation with transverse colon incarceration and omental gangrene treated laparoscopically. Case presentation: A 74-year-old man presented with sudden abdominal pain and recurrent vomiting approximately one month after a fall down stairs for which he had not sought medical attention. Examination revealed abdominal distension, absent bowel sounds, and diminished breath sounds over the right lower hemithorax. Chest radiography demonstrated an intrathoracic colonic loop, and computed tomography confirmed incarceration of the transverse colon through a right diaphragmatic defect. Laparoscopy identified an approximately 4 cm defect containing the transverse colon and greater omentum. After reduction, the colon was edematous but viable and was preserved; the gangrenous portion of the omentum was resected. The defect was closed without tension using interrupted non-absorbable monofilament sutures, without mesh or conversion. Recovery was uneventful, with mobilization on the day of surgery, a normal diet from postoperative day one, and discharge on postoperative day five. At three months, clinical assessment and chest radiography showed no symptoms or radiographic signs of recurrence. Conclusions: A recent history of trauma should prompt consideration of diaphragmatic hernia in patients with intestinal obstruction and abnormal thoracic findings. This case illustrates the feasibility of laparoscopic reduction, preservation of viable colon, selective omental resection, and primary repair in an appropriately selected patient.