Abstract
Introduction: Traumatic diaphragmatic rupture is a relatively uncommon complication of trauma. Its combination with an intercostal herniation has never been reported in a child.
Case presentation: A 10-year-old female presented after a high-speed motor vehicle crash, primarily suffering blunt thoraco-abdominal injuries. Imaging revealed a ruptured left diaphragm through which the stomach, spleen, left lobe of liver, distal pancreas, and jejunum had herniated. She had bilateral pulmonary contusions, grade II hepatic and splenic injuries. Laparotomy was performed, and the abdominal viscera were reduced. Primary closure of the diaphragmatic defect was achieved using 2/0 Ethibond, but the ruptured 7th intercostal space was not repaired. The patient recovered as was expected from a major traumatic event. At the 8-week clinical follow-up, she remained well, with no recurrence of the intercostal hernia and no ongoing symptoms.
Conclusion: TDIH is an extremely rare complication of paediatric trauma. Diaphragmatic repair without closure of the intercostal defect appears to be an appropriate treatment strategy in children.