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

R M G K Rathnayaka; Kalaventhan Pathinathan; S Sivamynthan; N Pirashanthan; Parathan Sriharan; Dilshan Munidasa

doi:10.1016/j.ijscr.2021.106517

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

Int J Surg Case Rep. 2021 Nov:88:106517. doi: 10.1016/j.ijscr.2021.106517. Epub 2021 Oct 16.

Authors

R M G K Rathnayaka¹, Kalaventhan Pathinathan², S Sivamynthan³, N Pirashanthan², Parathan Sriharan², Dilshan Munidasa⁴

Affiliations

¹ General Surgery, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka. Electronic address: rmgkgayankrishan@gmail.com.
² Orthopaedic Surgery, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.
³ General Surgery, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.
⁴ Department of Trauma and Orthopaedics, National Hospital-Colombo, Sri Lanka.

Abstract

Introduction and importance: The traumatic diaphragmatic hernia could be missed in the background of spinal fractures due to neurological weakness. We report the first case of the management of thoracolumbar fracture-dislocation associated with diaphragmatic injury.

Presentation of case: 53-year-old male transferred from local hospital following fallen from a motorbike on the 4th day after the injury. He was paraplegic from L1 below with sacral root involvement. Further imaging showed fracture-dislocation of the vertebral body at the T12-L1 level and anterior displacement of T11 on T12. The left-sided diaphragmatic hernia was detected by chest x-ray with bowel shadows in the left hemithorax. Emergency laparotomy and diaphragmatic repair followed by a posterior spinal exploration and pedicle screw fixation were done. Early mobilization was done after spinal fixation and the patient is successfully continuing rehabilitation.

Clinical discussion: Thoracolumbar fracture-dislocation associated with the traumatic diaphragmatic hernia is rare. Clinical diagnosis of associated visceral injuries could be delayed due to the neurological deficit of the patient. An initial concern was to repair the life-threatening diaphragmatic hernia. Even current studies showed improved neurological function from early spinal surgery, spinal fixation had to delay as surgery needs a prone position.

Conclusion: Early identification and management of traumatic diaphragmatic hernia are life-saving and allows early surgical intervention for the spine. Early reduction and fixation are associated with improved neurological function and will allow early mobilization and reduce hospital and ICU stay.

Keywords: Case report; Diaphragmatic hernia; Laparotomy; Spinal cord injury; Thoracolumbar spine.