A LATE PRESENTATION OF HEPATOTHORAX DUE TO HIGH-ENERGY BLUNT TRAUMA AND RIGHT DIAPHRAGMATIC RUPTURE rodrigo.ruizber@gmail.com

PE114

A LATE PRESENTATION OF HEPATOTHORAX DUE TO HIGH-ENERGY BLUNT TRAUMA AND RIGHT DIAPHRAGMATIC RUPTURE

4

Mexico

Oral or Poster

Hepatothorax, defined as hepatic herniation into the thoracic cavity, usually results from right diaphragmatic rupture following high-energy blunt trauma. Emergency surgical intervention aims to reduce the liver and perform primary diaphragmatic repair via thoracic or abdominal approach.

A 33-year-old female front-seat passenger, unrestrained during a high-impact motor vehicle collision, was ejected and sustained blunt trauma. Initial evaluation showed hemodynamic stability and mild dyspnea; FAST was negative. Discharge was followed by a contrast-enhanced CT scan revealing right diaphragmatic rupture and hepatothorax with phase-dependent hepatic changes. Three days later, worsening umbilical pain and dyspnea without hypoxia prompted surgery.

Right lateral thoracotomy revealed complete hepatic herniation into the right hemithorax with contralateral lung displacement. The diaphragm was mobilized, adhesions released, and the liver repositioned into the abdomen. The diaphragmatic defect was repaired and reinforced with PTFE mesh. Postoperative imaging confirmed bilateral lung expansion without residual injury. Late CT showed reparative diaphragmatic changes, fibrocicatricial basal lung alterations, and minimal pneumothorax <5%.

Right diaphragmatic rupture with hepatothorax is rare and challenging to diagnose due to subtle early symptoms and negative initial imaging. Timely surgical repair after recognition prevents respiratory compromise. This case underscores the importance of vigilance and early definitive management for optimal outcomes.