Introduction
Diaphragmatic injuries following penetrating thoracic trauma may be clinically subtle and challenging to detect radiologically. Computed tomography (CT) is the most reliable method for diagnosis but it may fail to demonstrate diaphragmatic injury. This case emphasizes the role of laparoscopy as a safe therapeutic and diagnostic tool.
Case presentation
A 13-year-old girl was brought to the emergency department after a physical assault resulting in a stab wound to the left thorax at the 6th intercostal space. Initial CT imaging showed minimal pneumothorax and subcutaneous emphysema, but no diaphragmatic defect. She was admitted to the pediatric intensive care unit. On the second hospital day, a left pleural effusion and pneumothorax developed, prompting chest tube insertion. Fat tissue was observed in the drainage system the following day, raising concern for diaphragmatic herniation. Diagnostic laparoscopy confirmed herniation of omental tissue through a left diaphragmatic defect, which was successfully reduced and repaired laparoscopically. Intraoperatively, the herniated omentum appeared infected, and purulent fluid was aspirated from the peritoneal cavity. Postoperative course was uneventful.
Conclusion
Radiological imaging methods may fail to detect diaphragmatic injury. In case of clinical suspect minimally invasive surgery will help diagnosis and treatment.
Keywords: Penetrating thoracic trauma, laparoscopy, omental herniation
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