121 MED ARH 2010; 64(2) • CASE REPORTS Laparoscopic Repair of Traumatic Diaphragmatic Hernia 1. INTRODUCTION Blunt trauma, today the common- est one due to motor vehicle accidents, cause multiple organ injuries (1). Dia- phragm injuries are seen in 2 to 6% of trauma patients (2). hey are diagnosed in the acute phase of blunt trauma only in 10 % of cases,and later more often they are identiied as hernia (3). Trau- matic diaphragmatic hernia presents unique obstacles to a minimal invasive approach. However, with the proper training and equipment, most of these hernias are amenable to laparoscopic approach. hese patients can expect the same well-known beneits of lapa- roscopic approach (4). This paper reports the case of a 56-year-old man, admitted in hospital with symptoms of vomiting, abdominal pain and dispnea who sustained blunt abdominal trauma in a high speed mo- tor vehicle accident nine months ago. X- ray and CT scans conirmed suspected strangulated diaphragmatic hernia. he emergency laparoscopic procedure was performed, and diaphragmatic defect was repaired with interruptured su- tures. 2. CASE REPORT A 56-year-man was admitted to our hospital with symptoms of vom- iting, abdominal pain and dispnea. From anamnestic data we found out that patient sufered severe injury in a high speed motor vehicle accident nine months ago. X-ray was performed im- mediately which conirmed previuously suspected strangulated diaphragmatic hernia. Hernia contained stomach, co- lon, major omentum and spleen in left hemitorax which were overlying and compressing left lung ield. Ultrasound and computed tomography (CT) scans conirmed diagnosis as well. he urgent laparoscopic procedure was performed. After creating pneu- moperi-toneum we placed four tro- cars. he whole abdominal cavity was explored at the start so as not to over- look other injuries. Omentum, colon and stomach were taken back through diaphragmatic defect (Figure 1,2) but the spleen was tighly ixed in toracal Laparoscopic Repair of Traumatic Diaphragmatic Hernia Ferid Latic 1, Samir Delibegovic 2 , Azra Latic 3 , Josip Samardzic 1 , Enver Zerem 3 , Djuro Miskic 1 , Vlatka Pitlovic 1 , Anhel Koluh 4 1 Department of Surgery, County Hospital, Slavonski Brod, Croatia 2 Department of Surgery, University Clinic Center Tuzla, Bosnia and Herzegovina 3 Department of Radiology, County Hospital. Slavonski Brod, Croatia 4 General Hospital, Nova Bila, Bosnia and Herzegovina CASE REPORT SUMMARY Diaphragm injuries are diagnosed in the acute phase of blunt trauma only in 10 % of cases - more often they are presented as hernia. Traumatic diaphragmatic hernia presents unique obstacles to a minimal invasive approach. However, with the proper training and equipment, most of these hernias are amenable to laparoscopic approach. These patients can expect the same well-known beneits of laparoscopic approach. We report here the case of a 56-year-old man, admitted to hospital with symptoms of vomiting, abdominal pain and dispnea who sustained blunt abdominal trauma in a high speed motor vehicle accident nine months ago. X-ray and CT scans confirmed suspected strangulated diaphragmatic hernia which contained stomach, colon, major omentum and spleen in left hemithorax. The urgent laparoscopic procedure was performed – omentum, colon and stomach were taken back through diaphragmatic defect but the spleen was tightly ixed in thoracal cavity and splenectomy was performed. The diaphragmatic defect was repaired with interruptured sutures. This case proves that laparoscopic repair of dia- phragmatic hernia is efective, but this should be carried out with caution, sometimes it needs ad- ditional complex procedure in emergency setting like splenectomy in this case. Keywords: traumatic diaphragmatic hernia, lapa- roscopy, splenectomy Corresponding author: Ass Prof Semir Delibegovic, MD, PhD. Department of Surgery, Clinical Center of University of Tuzla, Bosnia and Herzegovina. Tel.: + 387 61 149 131; fax: +387 35 250 474. E-mail: delibegovic.samir@gmail.com Figures 1 and 2. Omentum, colon and stomach are taken back through diaphragmatic defect.