Abstract:

Traumatic diaphragmatic injuries are rare but pose significant diagnostic and management challenges, particularly in acute cases involving blunt trauma. These injuries often present non-specific symptoms, leading to misdiagnosis or delayed intervention. The right hemi diaphragm is less commonly affected than the left, and its involvement is frequently associated with liver herniation and concomitant abdominal or thoracic injuries. We present the case of a 28-year-old female who sustained a blunt thoracoabdominal trauma after being struck by a moving vehicle. She arrived at the emergency department with complaints of pain in the neck, left shoulder, left side of the chest, and right arm. Initial assessments revealed hemodynamic stability, a Glasgow Coma Scale (GCS) score of 15/15, and decreased breath sounds in the right lung field. Imaging studies, including chest X-ray, CT scan, and MRI, confirmed the right diaphragmatic rupture with liver herniation, lung contusion, and a liver laceration. Given the extent of the injury, the patient underwent a combined surgical approach: a right thoracotomy for lung and diaphragmatic repair and a median laparotomy for liver laceration management. The diaphragm was repaired with suturing and mesh placement. Postoperatively, she remained stable, requiring bronchoscopy for lung collapse before successful recovery and discharge on postoperative day 20. This case highlights the importance of early recognition, accurate imaging, and a tailored surgical approach for diaphragmatic rupture. A combined thoracoabdominal approach provides optimal exposure and repair, ensuring favorable outcomes. Further research is necessary to establish standardized guidelines for managing complex diaphragmatic injuries.

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