Patients with traumatic diaphragmatic hernias mostly had a penetrant or blunt trauma history on the upper abdomen or lower chest, clinical symptoms may appear months or years after trauma.

Traumatic diaphragmatic hernias (TDH) are rare but life-threatening entities. Despite the widespread use of computed tomography in trauma cases, 9-41% of patients with TDH may stay unrecognized, or clinical symptoms may appear months or years later after trauma.

Diaphragm rupture develops at 0.8-5% of thoraco-abdominal traumas and 30% of these cases are presented in late period. Most of the diaphragm hernias (88-95%) occur in the left hemi-diaphragm, because of the protective effect of the liver on the right hemi-diaphragm. The mechanism of delayed TDH is explained by a sudden increase in the pleuroperitoneal pressure gradient. Stomach, transverse colon and liver are the most common herniated organs to the thorax. Mortality is associated with ischemia of herniated organs. In our patient, transverse colon was herniated to thorax, but we did not observe any ischemic signs in colon and we did not encounter any morbidity. Since the defect is usually smaller in patients with penetrating trauma compared to blunt trauma, incarceration and ischemia risk and also the mortality risk is higher in penetrant diaphragmatic hernias.

Surgery is the only treatment option in TDH. Transabdominal, transthoracic, laparoscopic and thoracoscopic approaches may be preferred. Open surgery provides some conveniences to surgeon; such as easy reduction and better evaluation of functional status and circulation of the organs, besides technically effortless diaphragm repair. On the other hand, laparoscopic or thoracoscopic approach is favoured for the advantages such as faster recovery, less postoperative pain and shorter hospital stay. Laparoscopy is superior than thoracoscopy in TDH, because laparoscopy allows reducing herniated organs more easily, allows assessment of the ischemic condition of the organs and furthermore both hemi-diaphragms can be evaluated during laparoscopic surgery, while thoracoscopy allows only single hemi-diaphragmatic examination. We preferred laparoscopic method in our patient because of our limited experience in thoracoscopy and high volume of herniated organs.

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