Asian Journal of Pediatric Research

Aims: Diaphragmatic hernias are defined by herniation of the abdominal viscera into the thoracic cavity. Typically, Diaphragmatic Hernias are Congenital or Acquired in adulthood due to blunt or penetrating injury. Many complications are known to occur in association with a Diaphragmatic Hernia, Acute Pancreatitis occurring in this situation is very rare entity.

Presentation of Case: A 17 year old male child presented with acute onset abdominal pain, vomiting and breathlessness. Initial investigations and Chest Xray revealed diaphragmatic hernia and further evaluation was done. CT reported Acute Pancreatitis and Diaphragmatic Hernia with Splenic injury. Child was revealed to have had blunt trauma to the thorax and abdomen which was the cause for the traumatic diaphragmatic hernia. Surgical correction of Diaphragmatic hernia and conservative management of Acute Pancreatitis and Splenic injury were done. Child recovered well.

Discussion: Small diaphragmatic hernias may remain undetected for months or even years until patients develop symptoms. Clinicians should consider diaphragmatic hernia in individuals with a history of trauma presenting with atypical abdominal or respiratory manifestations (Dinc et al., 2015).

Pancreas are mainly found in cases of Hiatal Hernias or Congenital Hernias. Traumatic Diaphragmatic hernia accompanied by Acute Pancreatitis is an extremely rare phenomenon with very few cases reported in literature (Dinc et al., 2015).

A potential mechanism of pancreatitis is pancreatic ischemia due to traction effect, or pancreatic duct obstruction.

Conclusion: Traumatic Diaphragmatic Hernia can have a late presentation, so any child with acute onset of respiratory distress, abdominal complaints with even a remote history of trauma should undergo prompt evaluation to ensure detection and correction of Herniation.