The authors report a case of intrapericardial transdiaphragmatic hernia due to blunt trauma and review about 37 similar cases. They conclude that traffic accidents with motor vehicles are responsible for 71.05% of these injuries. Patients presented delayed symptons predominantly involving the heart and gastrointestinal tract. However, heart failure was confirmed only twice. In most cases GI symptoms were confirmed by signs of rigidity, distensions or visceral occlusions. The diagnosis in 28.94% of cases was made using barium contrast radiology. A diaphragmatic hernia was suspected in 57.89%. All cases were managed surgically with few postoperative complications and only three deaths (7.89%). The transition between the central tendinous diaphragmatic center and the basal pericardium was the common site of rupture in all cases. The transverse colon was the most herniate viscera of the abdominal cavity. In some cases the ruptures affected the diaphragmatic hemicupulas allowing hernias into the pleural spaces. Theories about the existence of embryonic weak points in the hemicupulas, of slimmer central phrenocardial anatomic regions and the possibility of latent periods occurring for hernia formation are discussed with the proper arguments. Selective details of the supplementary tests are included to facilitate the diagnosis. Critical analyses are realized concerning the surgical approach and suggestions are presented regarding the abdominal or thoracic approach.
Hernia diaphragmatic, traumatic; Pericardium; Hernia diaphragmatic, traumatic
