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Rare association of traumatic diaphragmatic hernia with spinal cord injury: A case report

International Journal of Surgery Case Reports, 2021 · DOI: https://doi.org/10.1016/j.ijscr.2021.106517 · Published: October 16, 2021

Spinal Cord InjuryTraumaOrthopedics

Simple Explanation

This case report describes a rare instance of a patient who suffered both a traumatic diaphragmatic hernia and a spinal cord injury following a motorbike accident. The diaphragmatic hernia, where abdominal organs protrude into the chest cavity, was initially missed due to the more prominent spinal injury. The patient underwent emergency laparotomy to repair the hernia, followed by spinal fixation surgery. Early mobilization was initiated post-surgery, and the patient began rehabilitation. The report highlights the challenges in diagnosing visceral injuries in patients with neurological deficits and emphasizes the importance of early identification and management of both the diaphragmatic hernia and spinal injuries for improved outcomes.

Study Duration
Not specified
Participants
One 53-year-old male
Evidence Level
Case Report

Key Findings

  • 1
    The case demonstrates the rare co-occurrence of traumatic diaphragmatic hernia with thoracolumbar fracture-dislocation and spinal cord injury.
  • 2
    Early identification and surgical management of the diaphragmatic hernia are crucial for patient survival and to enable subsequent spinal fixation.
  • 3
    Neurological deficits can mask associated visceral injuries, emphasizing the need for thorough diagnostic evaluation in trauma patients.

Research Summary

This case report details the management of a 53-year-old male who sustained a thoracolumbar fracture-dislocation and a diaphragmatic hernia after a motorbike accident. The patient presented with paraplegia and bowel shadows in the left hemithorax, indicating the hernia. Emergency laparotomy was performed to repair the diaphragmatic hernia, followed by spinal fixation surgery. The patient underwent rehabilitation and showed some neurological improvement. The report emphasizes the importance of considering associated injuries, such as diaphragmatic hernia, in patients with spinal cord injuries and highlights the need for early diagnosis and management to improve patient outcomes.

Practical Implications

Enhanced Diagnostic Vigilance

Clinicians should maintain a high index of suspicion for diaphragmatic injuries in patients with high-energy spinal fractures, even in the presence of neurological deficits.

Expedited Surgical Intervention

Early identification and repair of traumatic diaphragmatic hernias can facilitate timely spinal fixation and improve neurological outcomes.

Comprehensive Trauma Management

A multidisciplinary approach is essential for managing complex trauma cases involving both spinal cord injuries and visceral injuries.

Study Limitations

  • 1
    Single case report limits generalizability.
  • 2
    Delayed spinal fixation due to pandemic situation may have affected neurological outcomes.
  • 3
    Lack of long-term follow-up data.

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