Diaphragmatic hernia as a long term complication after a stab wound of theabdomen

The treatment of stab wounds of the abdomen is discussed controversely. The managment of these wounds depends on a high degree on the clinical situati on of the patient. Repeated physical examination, peritoneal lavage and lap arotomy are recommended. The identification of an isolated diaphragmatic in jury is worrisome because its subtle clinical presentation is often not all eviated by adjunctive tests. Delayed recognition of an incarcerated diaphra gmatic hernia has a high mortality rate. We report about an 23 year old Afr ican male, who was injured by an intraabdominal stab wound. Initially he di d not have any clinical problems, but after 6 months he was admitted to the hospital due to severe pulmonary complications. A diaphragmatic hernia wit h dislocation of the transverse colon into the left thorax was identified o n x-rays. A thoracotomy as well as a laparotomy were performed to restore t he anatomic conditions and to dose the hernia. After two weeks, the patient could leave the hospital without pulmonary complications. Under considerat ion of the literature we recommend exploratory laparotomy for stab wounds t hat penetrate the left side of the chest below the fourth intercostal space anteriorly,the sixth intercostal space laterally and the tip of the scapul a posteriorly. The high mortality rate after a delayed recognition appears to justify an early operative approach.