# Post-Traumatic Diaphragmatic Hernia Presenting as Bowel Obstruction 12 Years After a Chest Gunshot Wound: A Rare Delayed Diagnosis

## TL;DR

A rare case of delayed diaphragmatic hernia caused by a past chest injury led to fatal bowel obstruction 12 years later, emphasizing the need for early diagnosis and surgery.

## Contribution

Highlights a rare delayed presentation of PTDH in Africa and its fatal outcome due to bowel obstruction.

## Key findings

- Delayed PTDH can present as acute bowel obstruction years after trauma.
- Fatal outcomes can occur without urgent surgical intervention.
- Fewer than 10 delayed PTDH cases have been documented in Africa over 30 years.

## Abstract

Post-traumatic diaphragmatic hernia (PTDH) is defined as the migration of intra-abdominal organs into the chest through a pathological defect in the diaphragm caused by trauma. PTDH is a rare condition, occurring in 3%–7% of all thoracoabdominal injuries. Approximately 14.6% of PTDH cases present months to years after the initial trauma. Cases of delayed PTDH complicated by bowel obstruction and perforation are exceedingly uncommon, with a reported prevalence of 0.17%–6%. In Africa, fewer than 10 cases of delayed PTDH have been documented over the past three decades. Despite the availability of published reports, there are no established practice guidelines for managing PTDH. Here, we present a case of delayed PTDH that manifested as acute bowel obstruction 12 years after a gunshot wound to the chest. The condition led to a fatal postoperative outcome. This case highlights the critical need for clinicians to consider PTDH in patients with a history of trauma presenting with acute bowel obstruction and underscores the importance of urgent surgical management to prevent fatal complications.