Partial liver herniation into the right chest following trauma: A delayed presentation as acute injury managed by laparoscopically assisted mini-thoracotomy

Introduction: Traumatic diaphragmatic rupture is a relatively uncommon occurrence, with an incidence of 0.8-5% reported in the literature. The reported percentage of missed diaphragmatic injuries that were discovered later ranges from 12 to 66%. Herniation of the liver through the right diaphragm has been reported in the literature after liver transplantation, and in trauma populations. Materials and methods: Here, we report a case of late identification of partial liver herniation into the right chest (8 years post initial injury), due to a recent motor vehicle crash. Thought to be suffering from an acute injury, the patient was taken to the operating room and a laparoscopically assisted mini-thoracotomy was performed. An old diaphragmatic injury was found intraoperatively; laparoscopically assisted mini-thoracotomy was used to repair the diaphragm, and the liver was returned into the abdomen. Conclusion: Right-sided diaphragmatic laceration, if diagnosed at the time of injury, may be repaired with the minimally invasive technique we describe here.