Delayed Traumatic Diaphragmatic Hernia Presenting With Gastric Volvulus and Necrosis: A Case Report and Literature Review

Traumatic diaphragmatic hernia (TDH) is an uncommon condition resulting from blunt or penetrating thoracoabdominal trauma and is frequently underdiagnosed due to its nonspecific presentation. Delayed diagnosis may occur months or even years after the initial injury, increasing the risk of serious complications. Left-sided involvement is more common, and defects typically occur in areas of embryologic weakness. The persistent pressure gradient between the abdominal and thoracic cavities promotes progressive herniation of abdominal viscera. The stomach is commonly involved, and its displacement into the thoracic cavity may predispose to gastric volvulus. This can compromise vascular perfusion, leading to ischemia, necrosis, and perforation. We report the case of a 25-year-old male with a history of penetrating thoracoabdominal trauma due to a stab wound to the left hemithorax four years prior to presentation. He was admitted with a four-day history of progressive left upper quadrant abdominal pain associated with nausea. Imaging studies revealed a left-sided diaphragmatic hernia with intrathoracic herniation of the stomach, complicated by gastric volvulus and ischemia. Contrast-enhanced computed tomography was essential for diagnosis, allowing precise identification of the diaphragmatic defect, herniated viscera, and associated complications, thereby guiding surgical management. The patient underwent surgical intervention with reduction of herniated contents, partial gastrectomy due to extensive necrosis, and primary repair of the diaphragmatic defect. This case underscores the potential for rapid progression to life-threatening complications, including gastric necrosis, in delayed TDH. Early recognition and prompt surgical intervention remain critical to improving outcomes.