Citation

Kamboj AK, Shen KR, Tapias LF. J. Gastroenterol. Hepatol. 2023; ePub(ePub): ePub.

Copyright

(Copyright © 2023, John Wiley and Sons)

DOI

10.1111/jgh.16323

PMID

37563774

Abstract

A 55-year-old woman presented with a 3-year history of progressively worsening dyspnea which was worse when she was supine. This began after a serious motor vehicle accident where several airbags deployed and she sustained a compound fracture of the leg, requiring multiple orthopedic surgeries and had significant abdominal bruising from seatbelt/airbag impact. Over the past few months, the dyspnea had worsened with bending and activity, and she was now unable to lay supine. She had no significant chronic health conditions and was a lifetime nonsmoker.

At presentation to the clinic, patient was hemodynamically stable with blood pressure 140/93, heart rate 85 bpm, respiratory rate 16, and SpO2 96% on room air. Physical examination demonstrated diffuse abdominal tenderness to palpation without rebound tenderness or guarding. Computed tomography (CT) chest without IV contrast demonstrated a very large right diaphragmatic rupture and diaphragm defect with nearly the entire liver, gallbladder, abdominal fat, small intestine, and colon herniating into the right chest, extending all the way to the right apex posteriorly (Fig. 1a-c). There was related compressive atelectasis of the right lung and related mild displacement in the mediastinum to the left. Based on the patient history, the diaphragmatic rupture was traumatic in origin following the motor vehicle accident that had occurred 3 years prior and was missed at original presentation...

Language: en