PMC6814919_01
Preoperative erect chest x-ray of case 1 showing an irregularly shaped homogenous opacity in the right lower zone, loss of the right hemidiaphragmatic contour, a chest tube and minimal subcutaneous emphysema. Preoperative chest CT scan of case 1 showing a complete rupture of right hemidiaphragm with herniated liver with capsular laceration
PAMJ-33-256-g001.jpg
PMC6814919_01_PAMJ-33-256-g001.jpg
f0001
Chest radiography and chest CT scan confirmed a right diaphragmatic injury with herniated liver as shown in Figure 1 and Figure 2.
Intraoperative pictures of case 1 showing ruptured diaphragm with herniated liver and the repaired diaphragm
PAMJ-33-256-g002.jpg
PMC6814919_01_PAMJ-33-256-g002.jpg
f0003
There was a 15cm transverse laceration of the right hemidiaphragm with herniation of the liver into the thoracic cavity, 280mls of hemothorax, fracture of the right 7th and 8th ribs and a collapsed and contused right lower lobe lung with intact pericardium, shown in Figure 3.
PMC6814919_02
Preoperative chest x-ray of case 2 showing right chest opacity with loss of right diaphragmatic contour and contralateral shift of the medisternum
PAMJ-33-256-g003.jpg
PMC6814919_02_PAMJ-33-256-g003.jpg
f0004
An urgent head CT scan showed no fractures or intracranial collections, but a chest radiograph showed massive opacity of the right hemithorax as shown in the Figure 4 and the loss of the right hemidiaphgramatic contour.
Intraoperative pictures of case 2 showing ruptured right diaphgram with herniated liver adherent to the edges and the postrepair
PAMJ-33-256-g004.jpg
PMC6814919_02_PAMJ-33-256-g004.jpg
f0005
The findings included a complete transverse rupture of the right hemidiaphragm with fibrinous adhesions between the edges of the ruptured diaphragm and the herniated liver and 300mls of serosanguinous pleural effusion as shown in Figure 5.
Postoperative erect chest x-ray of case 2 showing adequate bilateral lung expansion
PAMJ-33-256-g005.jpg
PMC6814919_02_PAMJ-33-256-g005.jpg
f0006
She developed small right pleural effusion one week after discharge and superficial thoracotomy wound infection which were managed conservatively with antibiotics and she has been well one year after surgery with adequate bilateral lung expansion as shown in Figure 6.