Upper Gastrointestinal Bleeding as Delayed Presentation of Traumatic Diaphragmatic Hernia: a Case Report

Case reports, Gastrointestinal hemorrhage, Hernia, diaphragmatic, traumatic, Wounds, stab


Introduction: Traumatic diaphragmatic hernia (TDH) is one of the critical complications resulting from penetrating chest trauma. The rate of undiagnosed TDH equivocates 12-60%. The significant part of complications happens 1-4 years after the primary damage. Here, we report a case of delayed TDH presented with upper gastrointestinal bleeding (GIB) as an excuse to discuss this issue. Case presentation: The patient was a 35-year-old man, admitted with objection of abdominal pain. A nasogastric tube was inserted and fixed that resulted in drainage of about 500cc dark blood. He was candidate for emergent endoscopy due to upper GIB. During resuscitation measures, he suddenly developed respiratory distress that could not be justified by upper GIB alone. Therefore, bedside sonography discovered some soft tissue apart from lung tissue in the left hemithorax. After performing diagnostic measures, with diagnosis of diaphragmatic herniation and strangulation he underwent emergent surgery. Conclusion: Small diaphragmatic lesions, which usually result from stab wounds, may develop into larger injuries if left untreated and they might lead to a diaphragmatic hernia with a potential risk of early or late complications and mortality. One of the rare complications is GIB, which should be considered in a patient with past history of trauma and presentation of GIB.


Download data is not yet available.


1. Lu J, Wang B, Che X, Li X, Qiu G, He S, et al. Delayed traumatic diaphragmatic hernia: A case-series report and literature review. Medicine. 2016;95(32):e4362.
2. Stawicki SP, Lindsey DE. Missed traumatic injuries: a synopsis. Int J Acad Med. 2017;3(3):13-23.
3. Lim B, Teo L, Chiu M, Asinas-Tan M, Seow E. Traumatic diaphragmatic injuries: a retrospective review of the 12-year experience at a tertiary trauma centre. Singapore Med J. 2016;58(10):595-600.
4. Patlas MN, Leung VA, Romano L, Gagliardi N, Ponticiello G, Scaglione M. Diaphragmatic injuries: why do we struggle to detect them? Radiol Med. 2015;120(1):12-20.
5. Kapadia S, Jagroop S, Kumar A. Cameron ulcers: An atypical source for a massive upper gastrointestinal bleed. World J Gastroenterol. 2012;18(35):4959–61.
6. Ganie FA, Lone H, Lone GN, Wani ML, Ganie SA, Wani N-u-d, et al. Delayed Presentation of Traumatic Diaphragmatic Hernia: a Diagnosis of Suspicion with Increased Morbidity and Mortality. Trauma Mon. 2013;18(1):12-6.
7. Shreck G, Toalson T. Delayed presentation of traumatic rupture of the diaphragm. J Okla State Med Assoc. 2003;96(4):181-3.
8. Rafael AA, Rodrigues P, do Carmo L, Nascimento C, Machado J, da Fonseca JR. Late traumatic diaphragmatic hernia complicated by intrathoracic perforation and haemorrhagic gastric cyst: a rare combination. Acta Med Port. 2005;18(4):295-301 (abstract).
9. Khan M, Verma G. Traumatic diaphragmatic hernia presenting as a tension fecopneumothorax. Hernia. 2011;15(1):97-9.
10. Shanmuganathan K, Matsumoto J. Imaging of penetrating chest trauma. Radiol Clin North Am. 2006;44(2):225-38.
11. Blaivas M, Brannam L, Hawkins M, Lyon M, Sriram K. Bedside emergency ultrasonographic diagnosis of diaphragmatic rupture in blunt abdominal trauma. Am J Emerg Med. 2004;22(7):601-4.
12. Yucel M, Bas G, Kulalı F, Unal E, Ozpek A, Basak F, et al. Evaluation of diaphragm in penetrating left thoracoabdominal stab injuries: The role of multislice computed tomography. Injury. 2015;46(9):1734-7.
13. Leung VA, Patlas MN, Reid S, Coates A, Nicolaou S. Imaging of Traumatic Diaphragmatic Rupture: Evaluation of Diagnostic Accuracy at a Level 1 Trauma Centre. Can Assoc Radiol J. 2015;66(4):310-7.
14. Baldassarre E, Valenti G, Gambino M, Arturi A, Torino G, Porta IP, et al. The role of laparoscopy in the diagnosis and the treatment of missed diaphragmatic hernia after penetrating trauma. J Laparoendosc Adv Surg Tech A. 2007;17(3):302-6.
15. Matz A, Alis M, Charuzi I, Kyzer S. The role of laparoscopy in the diagnosis and treatment of missed diaphragmatic rupture. Surg Endosc. 2000;14(6):537-9.
16. Haciibrahimoglu G, Solak O, Olcmen A, Bedirhan MA, Solmazer N, Gurses A. Management of traumatic diaphragmatic rupture. Surg Today. 2004;34(2):111-4.
How to Cite
Arhami-Dolatabadi A, Forouzanfar M, Mirbaha S. Upper Gastrointestinal Bleeding as Delayed Presentation of Traumatic Diaphragmatic Hernia: a Case Report. Adv J Emerg Med. 2(3):e36.
Case (report / study)