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  • Title: [Late traumatic diaphragmatic hernia complicated by intrathoracic perforation and haemorrhagic gastric cyst: a rare combination].
    Author: Rafael AA, Rodrigues P, Carmo Ld, Nascimento C, Machado J, Fonseca JR.
    Journal: Acta Med Port; 2005; 18(4):295-301. PubMed ID: 16584662.
    Abstract:
    The authors describe the clinical and imagiologic challenges faced at the Emergency Room while observing a 48-year-old woman, submitted to a Nissen fundoplication 16 months earlier. She presented herself with a one-month total progressive dysphagia, epigastric pain and regurgitation. Intraoperative findings demonstrated an intraabdominal fundoplication, closure of diaphragmatic crura and part of the gastric greater curvature and body herniated through a small posterior defect on the diaphragm, with a gigantic serosal cystic mass and associated perforation. Data from posterior clinical investigation shows a traffic accident 34 years ago. Although described before, the association of late traumatic diaphragmatic hernia and gastric intrathoracic perforation is rare (< 2.5%) and difficult to diagnose. A revision of the literature is performed concerning the pathophysiologic mechanisms of late diaphragmatic rupture, its clinical presentation and diagnosis, as for Nissen fundoplication complications, its prevention and management.
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