Gastric incarceration and perforation following posttraumatic diaphragmatic hernia: case report and review of the literature.

OBJECTIVE Herniation of abdominal contents through the diaphragm has been described in a variety of diaphragmatic defects and may occur secondary to diaphragmatic injury, either traumatic or iatrogenic. The aim of this study is to report a case of gastro-pleural fistula in a patient with traumatic diaphragmatic hernia. CASE PRESENTATION An 18-year-old male patient, with a past history of blunt abdominal trauma, presented with epigastric abdominal pain and dyspnea. A thoracoabdominal CT scan revealed the presence of a herniated portion of the stomach with suspected perforation and free fluid in the left hemithorax. An exploratory laparotomy was performed. The esophageal hiatus was normal but a 4 cm rent was discovered in the posterior leaf of the left hemidiaphragm. Passing through the defect was the fundus of the stomach with evidence of perforation in left pleural space causing empyema. Resection of the herniated portion of the stomach and running suture of the gastric body were performed. Diaphragm was directly repaired without graft. Finally, a chest tube was placed in the left hemithorax. Postoperative course was uneventful and he recovered without complications. He was discharged from hospital 13 days after surgery.