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Panamerican Journal of Trauma, Critical Care & Emergency Surgery


Introduction: Traumatic diaphragmatic hernia (TDH) may develop several complications. Pericardial injury increases the severity of this entity and may lead to specific presentation and complications, that require immediate attention to avoid significant morbidity and mortality.

Objective: This study aims to report two cases of traumatic diaphragmatic hernia with pericardial extension with specific presentation or complication.

Clinical Case: Case 1: 34-year-old male suffered a fall of level of 8 meters high. Computed tomography (CT) scan showed herniation of the stomach into the left chest cavity, intraperitoneal fluid and pelvis and acetabulum fractures. He underwent exploratory laparotomy due to hemodynamic instability. In the immediate postoperative period, high amount of bloody output through chest tube was observed, requiring thoracotomy. At surgery, ligation of a bleeding vessel of the pericardium was performed. He showed good postoperative evolution, being discharged three weeks later. Case 2: 54-yearoldmale was hit by a motorcycle. Computed tomography scan showed herniation of the stomach into the pericardial sac. He developed clinical signs of cardiac tamponade and underwent laparotomy, which showed intrapericardial diaphragmatic hernia. It was reduced with immediate, but transient hemodynamic improvement. However, the patient developed multiple organ dysfunction, and died 2 days after admission.

Conclusion: Traumatic diaphragmatic hernia (TDH) with pericardial extension may show specific presentation and complications, such as pericardial tamponade by abdominal viscera and pericardial bleeding that can cause death if not identified and treated quickly.

Clinical significance: Due to the high morbidity and mortality of pericardial injury associated to diaphragmatic hernia, its early diagnosis through imaging or surgery has great importance, enabling adequate surgical approach and may improve the clinical outcome of the patients.

Keywords: Blunt trauma, Pericardial injury, Traumatic diaphragmatic hernia.

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