Unusual repair in a rare case of hepatothorax due to right-sided diaphragmatic rupture: case report

Intra-thoracic herniation of abdominal organs following diaphragmatic rupture represents an unusual clinical occurrence with great diagnostic difficulty. The authors present a case of right diaphragmatic rupture related to peritonitis due to perforated duodenal ulcer in previous (1 year before) thoraco-abdominal trauma with complete intra-thoracic herniation of the liver, gallbladder, ascending and transverse colon and lung collapse. The preoperative diagnosis has been based on clinical, chest X-ray, and ultrasound examination. The patient, because of very serious respiratory and hemodynamic distress, immediately underwent surgery (thoraco-laparotomic approach) with reduction of the liver, gallbladder, ascending and transverse colon in the abdominal cavity, perforated duodenal ulcer suture and repair of diaphragmatic tear using an unusual repair mode: suture of autologous fascia lata graft to the diaphragm. Postoperative chest radiography showed the normal location of right diaphragmatic border.