Diaphragmatic rupture secondary to blunt thoracic trauma.

We present a case of a 71-year-old male that was involved in a high-speed motor vehicle collision, as an unrestrained back seat passenger. On primary survey, decreased breath sounds and bowel sounds were auscultated in the left thorax. Secondary survey was positive for left anterior chest wall tenderness. Chest radiograph demonstrated multiple rib fractures, hemothorax, and diaphragmatic rupture with herniation of bowel loops into the chest cavity (Figure 1). Upon insertion of a nasogastric tube, repeat radiograph demonstrated the nasogastric tube to be in the left upper abdomen (Figure 2). The patient underwent emergency laparotomy for repair of his injury. Incidentally, a splenic laceration was identified intraoperatively. Successful repair of the diaphragmatic injury as well as splenectomy was achieved.