Table 1_Case Report: Diagnostic pitfalls and laparoscopic repair of a delayed large right-sided traumatic diaphragmatic hernia.docx

Computed tomography demonstrated discontinuity of the right hemidiaphragm and herniation of the stomach, liver, gallbladder, and hepatic flexure. Transabdominal laparoscopy confirmed an approximately 8.0 cm×15.0 cm posterolateral defect. After adhesiolysis, all herniated organs were reduced and remained viable.

The defect was closed primarily without mesh because the mobilized edges were robust and could be approximated without a residual gap, visible tearing, or excessive tension. Respiratory and gastrointestinal symptoms resolved, and early postoperative imaging confirmed restoration of the abdominal viscera below the diaphragm.</p>Conclusion<p>After high-energy trauma, discordant respiratory and meal-related symptoms plus intrathoracic bowel sounds should prompt targeted multiplanar CT review.

In selected stable patients, transabdominal laparoscopy can combine reduction, assessment of visceral viability, and repair. The approach and need for reinforcement should be individualized according to adhesions, tissue quality, and achievable edge approximation.</p>