Chief of Internal Medicine department SAN LUIS POTOSI, San Luis Potosi, Mexico
Disclosure(s):
Francisco Javier Marin, Sr.: No financial relationships to disclose
Background: Post-traumatic diaphragmatic hernia is a rare but potentially lethal condition that may cause obstructive shock by impairing cardiac filling and venous return, leading to acute hemodynamic deterioration(1-4). This study describes a rare case of obstructive shock secondary to post-traumatic diaphragmatic hernia, highlighting the importance of timely recognition.
Methods: Observational and descriptive case report analyzing the clinical and hemodynamic features of a rare presentation of obstructive shock secondary to post-traumatic diaphragmatic hernia.
Outcome: A 36-year-old male was admitted after a motorcycle accident presenting with severe shock (blood pressure 60/40 mmHg, heart rate 140 bpm, oxygen saturation 85%). Orotracheal intubation, mechanical ventilation, and central venous catheter placement were initiated. Computed tomography of the head, chest, and abdomen revealed a grade IV diaphragmatic hernia.
The patient underwent exploratory laparotomy with diaphragmatic repair. Vasoactive support, including norepinephrine, and crystalloid preload were initiated. Transthoracic echocardiography documented right ventricular systolic and diastolic dysfunction with pulmonary arterial hypertension, a TAPSE of 15 mm, and a TAPSE/PSAP ratio of 0.33. Levosimendan was initiated with volume preload according to guidelines.
Following surgical correction, the patient showed favorable clinical evolution, remained in the intensive care unit for 48 hours, and was discharged with a left pleural seal, achieving complete functional recovery within 10 days.
Conclusion: Obstructive shock secondary to post-traumatic diaphragmatic hernia is a rare condition characterized by impaired cardiac filling, increased intracardiac pressures, and reduced cardiac output. Early recognition, prompt surgical correction, and advanced hemodynamic management allow favorable outcomes even in severe presentations, as demonstrated in this case.
