Herniation of liver through a ruptured right diaphragm following blunt trauma

Background: Diaphragmatic rupture remains a diagnostic challenge because of the lack of an accurate test demonstrating the injury. Diaphragmatic rupture after thoracoabdominal trauma is uncommon, with a reported incidence ranging from 1% to 3% of patients suffering blunt trauma. Most ruptures are on the left side; with right sided diaphragmatic injury being the subject of a few case reports. Herniation of the liver through a ruptured diaphragm is rarer still. Case Report: We report a rare case of right sided diaphragmatic rupture with herniation of the liver in a 58 year old polytrauma patient. An initial chest X-ray had only revealed a right hemothorax, which was confi rmed on tube thoracostomy. At laparatomy a large tear in the right diaphragm with signifi - cant intrathoracic displacement of the liver was encountered. A thoracoabdominal approach was used to reposition the liver and repair the diaphragm. Conclusions: We discuss the pathophysiology, diffi culties associated with diagnosis and treatment options of diaphragmatic injuries.