DOI: 10.36347/sjmcr.2016.v04i04.018

Pages: 242-245

A 19-year-old male on a motorcycle collided with a truck, which resulted in a slip-slide accident. The patient was transported to the hospital in a physician-staffed emergency helicopter. Upon arrival at the hospital, he remained in cardiopulmonary arrest. An immediate chest roentgen showed decreased radiolucency of the left thorax, but the line of his left diaphragm was not abnormal. The patient underwent resuscitative thoracotomy for open heart massage, drainage of the hemothorax, and clump of the descending aorta. It was during thoracotomy that a lethal aortic injury was discovered. In addition, by accident, a left blunt traumatic diaphragmatic hernia was also discovered. The lacerated region of the diaphragm was occupied by the wall of the stomach and left lobe of the liver. Unfortunately, the patient did not recover spontaneous circulation. The initial diagnosis of a blunt traumatic injury to the diaphragm is generally difficult, as the early clinical and radiological findings are not clear. While, multi-detector computed tomography (CT) scanning has proven to be useful in diagnosing diaphragmatic injuries. In addition, surgical exploration is vital, and inspecting the diaphragm without considering clinical symptoms is highly recommended in all cases of severe truncal injury. Accordingly, the diaphragmatic injury should be suspected in all thoracoabdominal traumas. Lack of specific signs and symptoms is common and a high index of suspicion is required.