Traumatic right diaphragmatic rupture with pericardial laceration in a toddler: a case report

Abstract

Traumatic diaphragmatic rupture is rare in children, particularly on the right side due to the protective effect of the liver. Associated pericardial laceration further increases morbidity and mortality and is frequently missed. We report a 23 month old male toddler who presented with severe respiratory distress after being struck by a slow-moving truck. Clinical examination revealed asymmetric chest movement, absent right-sided air entry, and leftward displacement of the cardiac apex. Chest radiography demonstrated bowel pattern lucencies in the right hemithorax with loss of the right diaphragmatic outline. Emergency exploratory laparotomy revealed a large right diaphragmatic laceration with associated pericardial tear and herniation of the liver and bowel into the thoracic cavity. Surgical reduction and repair were performed with good postoperative recovery. This case highlights the importance of maintaining a high index of suspicion for right diaphragmatic rupture with pericardial injury in paediatric trauma, especially in resource-limited settings.