Diaphragmatic rupture after vigorous exercise

Excerpt

A 20 year old male patient, with no medical history, was brought to the emergency room (ER) due to abdominal pain in the left flank which worsened with food and liquid ingestion, causing nausea and abdominal bloating/distension. The patient mentioned three such episodes, each lasting four or five days, which started about one month previously, following a basketball match. Due to worsening of the symptoms, the patient went to the emergency room. No vomiting or diarrhoea was reported. At admission, vital signs were stable. Physical examination revealed diminished breathing sounds in the left hemithorax, and epigastric tenderness. The thorax X-ray showed an image that suggested gastric contents in the left thorax (Fig. 1a). A Computer Tomography scan (CT) confirmed a massive hernia occupying two thirds of the left thorax, suggesting possible diaphragmatic rupture with right mediastinum deviation and passive lung parenchyma collapse (Fig. 1b). The patient was taken to the operation room where a laparotomy was performed. Operative findings included a left diaphragmatic lesion about 2/3 of its external portion with herniation occupying about two thirds of the left hemithorax. The stomach, spleen, splenic flexure of the colon and a portion of the omentum were found in the thorax. Hernia reduction was carried out, and the diaphragm was repaired with nylon 00 suture. The patient was transferred to the Intermediate Care Unit (ICU) for post-operatory observation and pain management. The patient was discharged seven days after surgery with no major post-operative complications. Follow-up consultations were done one week, and then one month later, with no further complaints and normal abdominal X-ray findings.

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