A 47-year-old male had a positive FAST exam and was hemodynamically unstable after a motor vehicle accident. He underwent abdominal exploration, small bowel resection and tissue sealant placed on a grade I liver laceration. Exploration also revealed an old left sided diaphragmatic hernia with fundus of stomach and spleen in the chest.
The defect was repaired primarily with #1 non-absorbable braided sutures and a left chest tube was placed. Post-operatively, additional history was obtained of a left chest stab wound 20 years previously with pneumothorax treated with chest tube drainage (see discussion.) The patient had been asymptomatic in the intervening time.
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