Right-sided diaphragmatic rupture after trauma—hepatothorax: a diagnostic challenge

Background: Traumatic diaphragmatic rupture is an uncommon condition. Furthermore, due to the shielding effect of the liver, right-sided ruptures occur less frequently than left-sided ones. We report two unusual cases of right-sided diaphragmatic rupture due to trauma and describe our experience to aid medical professionals in their diagnosis and management. Purpose: This report focuses on two atypical cases of right-sided traumatic diaphragmatic rupture causing herniation of the liver into the right thorax, a rare condition, and this provides insights for healthcare professionals regarding diagnosis and management. Case: We present two case reports involving male patients aged 64 and 56 who sustained right-sided diaphragmatic ruptures due to blunt trauma mechanisms—a motorcycle accident and a similar road traffic accident, respectively. Clinical examinations and imaging studies revealed hemothorax and elevated right dome of the diaphragm in Case 1 and pneumoperitoneum and multiple fractured ribs with elevated right dome of diaphragm and minimal hemothorax in Case 2. Surgical interventions were conducted for both patients; Case 1 confirmed a right diaphragmatic rupture with liver herniation, which was successfully repaired, and Case 2 surgical intervention revealed a large right-sided diaphragmatic tear, with liver herniating into the thorax. A successful reduction of the liver and closure of the defect were performed. Conclusion: Diaphragmatic rupture should be considered as a differential in patients involved in any abdominal trauma, specifically on the right side, as the presentation is often subtle. Chest x-ray and computed tomography are essential tools to confirm the diagnosis. Surgical repair of the defect is the standard treatment.