Experience of video-assisted thoracic surgery for left traumatic diaphragmatic hernia, a case report

A case of the left traumatic diaphragmatic hernia treated by video-assisted thoracic surgery was experienced. A 21-year-old male was admitted to our hospital due to the thoracic and abdominal blunt trauma sustained in a traffic accident. Chest X-rays on admission revealed only a slight degree of left pneumothorax and the left 5th and 9th rib fractures. On the tenth hospital day, he underwent a gastrointestinal fiberscopy due to a persistent upper abdominal dull pain, followed by an appearance of an abnormal shadow at the left cardiophrenic angle on chest X-ray. The diagnosis of the left traumatic diaphragmatic hernia was established by radiological examinations. Video-assisted thoracic surgery was performed for the reposition of the hernia on the thirteenth hospital day. A slight degree of bloody effusion, a part of the transverse colon, the greater omentum, the stomach and the spleen were found in the thoracic cavity. No injury was seen on those organs. Left diaphragm was found to be ruptured sagittally for about 9 cm in length, up to the splenic hilum posteriorly. Although the reposition of these organs but the spleen was feasible under the thoracoscopy, the combined mini-thoracotomy for approximately 5 cm in length was necessary to replace the spleen safely. The lacerated diaphragm was repaired by direct suture. The postoperative course was uneventful, and he was discharged from our hospital on the tenth postoperative day. It was suggested to be possible to treat the traumatic diaphragmatic hernia with a thoracoscopic surgery when the injury or adhesion of herniated organs are not likely to be present, although the combined mini-thoracotomy was recommended in the case with the splenic herniation.