Introduction: Diaphragmatic injuries occur in 1-7% of patients with significant blunt abdominal trauma. If the injury is not diagnosed initially, it can lead to chronic herniation. Following the introduction of minimally invasive operative techniques, laparoscopy enjoyed general acceptance in the diagnosis, then both the diagnosis and treatment, of acute traumatic diaphragmatic hernia following stab wounds. The role of laparoscopy in the management of chronic diaphragmatic hernia following blunt trauma is less clear.

Methods: In this film the utility of laparoscopy is depicted in a 45 year old man with brief history of upper abdominal pain, vomiting, and dyspnea. One year earlier, he sustained blunt chest and lower extremity trauma in a motor vehicle crash. Multiple left-sided rib fractures were noted. He recovered and remained symptom free for one year. At presentation, breath sounds were decreased on the left side and there was epigastric tenderness. Chest X-ray indicated abdominal visceral herniation through the left hemidiaphragm. Computed tomography (CT) of the torso with coronal & sagittal reconstructions confirmed entrapped large bowel & omentum. Laparoscopic reduction of the hernia and repair of the injured diaphragm was performed.

Results: The chest radiograph and dynamic CT reconstructions are displayed. The procedure shows the configuration of port placement, the approach to the diaphragm, endoscopic liver retraction, the technique of hernia reduction with hemostatic adhesiolysis, and placement of sutures, with intra-corporeal tying, to effect closure of the defect.

Conclusion: Laparoscopic surgery is effective in the management of traumatic diaphragmatic hernia in the hands of the experienced laparoscopist.