Paper Title
A Delayed Presentation of Traumatic Right Hemidiaphragm Injury Repaired Via A Laparoscopic Approach: A Case Report

Introduction Diaphragmatic injury is a rare clinical entity which presents a diagnostic and therapeutic challenge. It is three times more common following blunt trauma than penetrating trauma and results in larger tears. A high index of suspicion is required to diagnose diaphragmatic injury. A missed diagnosis following acute injury can later result in life-threatening complications. Case Presentation We describe the successful management of a right hemidiaphragmatic injury presenting two weeks following blunt thoracoabdominal trauma using a laparoscopic mesh repair. Discussion Diaphragmatic injury is rare, with right-sided injuries less common due to the buffering effect of the liver. The diagnosis is made within 24 hours of injury in 75% of cases. In our patient, symptoms of a right-sided diaphragmatic injury manifested two weeks following a motor vehicle collision. A CT scan of the chest and abdomen confirmed the diagnosis. According to DeBlasio, intermittent symptoms of visceral herniation or incorrect x-ray interpretation are the main reasons for a delayed diagnosis. Contrary to common practice where thoracotomy is the preferred method for repair in the absence of associated abdominal injuries, we demonstrated that a right-sided diaphragmatic injury can be successfully managed with a laparoscopic mesh repair. Conclusion Traumatic diaphragmatic injury remains a challenge to emergency physicians and trauma surgeons. Clinicians should be aware of the differing clinical presentations, investigations, and management. Surgical repair can be achieved via laparoscopy, thoracoscopy, laparotomy, and/or thoracotomy. In the case of an isolated right-sided diaphragmatic injury, laparoscopic mesh repair should be considered. Keywords - Traumatic Diaphragm Injury, Delayed Presentation, Laparoscopic Approach, Mesh Repair