Delayed hepatothorax: An unusual presentation case report

• Published in: International journal of surgery case reports 2022-05, Vol.94, p.107017-107017, Article 107017
• Main Authors: Maldonado-Chaar, Sergio M., Miró-González, Ángel A., Ramírez, Norman, Ramirez-Ferrer, Luis O.
• Format: Article
• Language: English
• Subjects: Case Report; Delayed hernia; Diaphragmatic hernia; Gastritis; Hepatothorax; Traumatic hernia
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2022.107017

We are reporting a case of a delayed hepatothorax due to a right-sided diaphragmatic rupture 13 years after a blunt trauma due to a motor vehicle accident, who presented as isolated gastritis without any type of respiratory symptomatology. Patient refers that his symptoms remained refractory to medical treatment and had gotten worse over time. Chest wall inspection showed asymmetric thoracic expansion and a decreased movement of right hemithorax when compared to the left. Cardiorespiratory auscultation was significant for growling sounds on the right second intercostal space and reduction of breath sounds on the right lower lobe region of the lung when compared to the left side. Thoracotomy was indicated since patient presented late. Meanwhile, laparotomy would have been appropriate if the patient had presented immediately after trauma. After the procedure, the patient presented in great condition and all the gastrointestinal symptoms associated with the traumatic diaphragmatic hernia had resolved. We propose that the absence of respiratory symptoms in our patient could be due to the progressive adaptation of small, cumulative changes in decreasing breathing capacity through time. A case like ours has not been reported in the literature and clinicians should take this case report into consideration when suspecting a possible diagnosis of a delayed traumatic diaphragmatic hernia that may be complicated by a hepatothorax. We recommend maintaining a high index of clinical suspicion for hepatothorax due to delayed traumatic diaphragmatic hernia for all patients with a history of trauma. •Hepatothorax is a rare and severe complication of right diaphragmatic ruptures.•A unique case where a patient presented with only gastrointestinal symptoms•Thoracotomy approach used due to delayed presentation•High index of suspicion should be maintained for patients with trauma history.