Reporting Two Rare Cases of Surgical Management of Herniated Intrathoracic Gastric Perforation in Traumatic Diaphragmatic Rupture

Gastric perforation into the thoracic cavity through a diaphragmatic rupture is rare but, when it occurs,
patients present in severe distress, with mortality approaching 50%. We present our experience of two
rare and unusual cases of traumatic diaphragmatic rupture from penetrating chest injury associated
with herniated intrathoracic gastric perforation over a five-year period from January 2015 to December
2020 at the cardiovascular and thoracic surgery department of the Komfo Anokye Teaching Hospital
in Kumasi, Ghana. Both patients underwent successful surgical repair through standard posterolateral
thoracotomy with one having earlier negative exploratory laparotomy. The essence of the paper is to
share and discuss the clinical presentation, diagnostic challenges, surgical management and the
postoperative care of this very rare complication of traumatic diaphragmatic rupture. The association
of traumatic diaphragmatic rupture with herniated intrathoracic gastric perforation is extremely rare
with an associated high morbidity and mortality. The diagnosis needs high index of suspicion. Rapid
resuscitation and early surgery via thoracotomy save lifes even in less resource centres.