# Tension pneumothorax from large bowel herniation and perforation as a late presentation of traumatic diaphragmatic hernia during pregnancy: a case report

## TL;DR

A rare case of tension pneumothorax caused by a delayed traumatic diaphragmatic hernia during pregnancy is reported, highlighting the importance of trauma history in diagnosis.

## Contribution

This is the third documented case of a late-presenting trauma-related diaphragmatic hernia during pregnancy complicated by tension pneumothorax.

## Key findings

- A 30-year-old pregnant woman presented with tension pneumothorax caused by a traumatic diaphragmatic hernia.
- The patient had a history of thoracic trauma eight years prior, which likely contributed to the hernia.
- Multidisciplinary management led to successful treatment with cesarean section and surgical repair.

## Abstract

Diaphragmatic hernias can be congenital or acquired, with trauma being the primary cause of the latter. Both types may have delayed presentations, with abdominal organs protruding into the thoracic cavity, causing symptoms of varying severity. Pregnancy can sometimes precipitate the condition. Tension pneumothorax resulting from bowel perforation into the thorax is exceptionally rare, with only a few cases reported. To the best of the authors knowledge, this is the third documented case of a late-presenting trauma-related diaphragmatic hernia during pregnancy, complicated by tension pneumothorax.

A 30-year-old woman, 29 weeks pregnant, was referred to Semmelweis University emergency department with moderate dyspnea. Initial investigation revealed tension pneumothorax. Chest tube placement released air, pus, and feces. Computer tomography identified a diaphragmatic hernia with bowel incarceration and perforation as the underlying cause. The patient underwent a delayed cesarean section and surgical repair, with a good outcome. A history of thoracic trauma eight years prior was later revealed.

Evaluating pregnant patients with shortness of breath in the emergency department is challenging. Identifying a history of thoracic or abdominal trauma is crucial, as this can raise the suspicion of diaphragmatic hernia, which can present with a wide range of symptoms. Spontaneous tension pneumothorax in pregnant women is extremely rare and requires cautious management. A multidisciplinary approach is crucial for the successful treatment of maternal diaphragmatic hernia.

The online version contains supplementary material available at 10.1186/s12245-025-00843-1.