• Bassam Abboud, Joe Bou Jaoude, Moussa Riachi, Ghassan Sleilaty, and Georges Tabet.
• Department of General Surgery, Hôtel-Dieu de France Hospital, Alfred Naccache Street, Beirut, Lebanon. dbabboud@yahoo.fr
• J Med Liban. 2004 Jul 1; 52 (3): 168-70.

ObjectiveHerniation of abdominal contents through the diaphragm has been described for a variety of diaphragmatic defects and may be secondary to diaphragmatic injury, either traumatic or iatrogenic. The sequelae of diaphragmatic hernia include intestinal obstruction, strangulation, gangrene and, eventually, perforation. The aim of this study was to report a case of intrathoracic infarction of transverse colon and two meters of small bowel in a patient with traumatic diaphragmatic hernia.PatientYoung man with past history of blunt abdominal trauma presented abdominal pain with dyspnea. An exploratory laparotomy was performed. The esophageal hiatus was normal but a 4.5 cm rent was discovered in the posterior leaf of the left hemidiaphragm. Passing through the defect was the transverse colon and a proximal small bowel. The herniated transverse colon and jejunum were massively dilated with evidence of infarction. Transverse colectomy and resection of two meters of jejunum with direct anastomosis were performed. Following bowel removal, diaphragm was directly repaired without graft. Finally, a chest tube was placed in the left hemithorax.ResultsPostoperative course was uneventful and he recovered without complications. He was discharged from hospital 10 days after surgery.ConclusionSurgeons, internists and emergency medicine personnel should be aware of the possibility of diaphragmatic hernia in patients with a known history of abdominal trauma. Though uncommon, strangulation of colon and small bowel through a rent in diaphragm should be considered when there is radiologic evidence of herniation.

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