However, the imaging investigation ruled out a central nervous system lesion as the cause of the patient’s symptoms i.e. vomiting. The consistency of symptoms as well as the alterations Syk inhibitor of pain

characteristics during the initial phase of patient’s observation was the main arguments for the additional imaging workup [18]. The pathognomonic sign in the chest x-ray with the stomach or the nasogastric tube in the hemithorax was not present in the chest radiography conducted at the trauma resuscitation unit. However, a nasogastric tube placement was contraindicated in our patient due to maxillofacial injuries and additionally a high quality chest x-ray could not be obtained until a https://www.selleckchem.com/products/JNJ-26481585.html work-up that could reliably rule out a cervical spine injury conducted. Within the framework of a more meticulous investigation in order to delineate occult pathology to justify the clinical symptoms, a second chest x-ray under more appropriate conditions GS-1101 at the radiology department was obtained. The presence of the stomach within the left hemithorax was observed. Abdominal CT scan confirmed the herniation

of the stomach into the chest and additionally ruled out any associated intraabdominal injuries. An urgent laparotomy at the base of DR was conducted. Regarding the repair technique we used intermittent non absorbable suture material in order to approximate the edges of the diaphragmatic defect. We assumed Megestrol Acetate that the use of a prosthetic mesh in the given case with the relatively small diaphragmatic defect would increase the risk of infection and the procedure cost without corresponding benefits in the long term. Conclusions Increased level of suspicion is essential in order to diagnose timely blunt DR in multiple trauma patients. Early diagnosis can lead to the proper surgical management and reduce the incidence of hernia related complications. Consent Written informed consent was obtained from the patient for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

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