Traumatic Intrapericardial Diaphragmatic Hernia

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Abstract
Traumatic intrapericardial herniation of abdominal viscera is very rare. Only five well documented cases (Brooks, 1953; Crawshaw, 1952; Moore, 1959; Smith and Lippert, 1958; Stein, Colmore and Green, 1953) have been reported. In each case the intrapericardial location was only established during exploration. In our case an intrapericardial hernia was suspected. Following diagnostic pneumoperitoneum air in the pericardium (Fig. 3) made possible a definite diagnosis. To our knowledge this was the first case where a diagnostic pneumoperitoneum was applied and a definite preoperative diagnosis made. The correct preoperative diagnosis can be decisive in the surgical approach. The purely intrapericardial herniation lends itself best for repairs through an abdominal exposure similar to a Morgagni hernia. A 38-year-old negro male was admitted to the hospital on 10.2.64 following an automobile accident in which he was the driver. Patient sustained a severe trauma to his chest, forehead and thigh. He was unconscious for an unknown period of time. Physical examination revealed a well-built, well-nourished male in moderate distress. Patient had severe chest pain on the left side with decreased diaphragmatic excursion. He also had a superficial laceration of the forehead and severe pain and swelling on the left upper thigh. Routine laboratory examination was within normal limits. The electrocardiogram revealed a right bundle branch block. Radiographic examination: chest. There were complete transverse fractures involving the 2nd to 10th ribs inclusive with the exception of the 6th rib. Pleural reaction was present at the left base with elevation of the left hemidiaphragm.