Abstract
BACKGROUND Diaphragmatic pericardial hernias (DPH) are a rare and potentially life-threatening variant of diaphragmatic rupture, most often arising after high-velocity blunt thoracoabdominal trauma. Clinical presentations range from acute cardiorespiratory compromise to delayed, insidious symptoms such as chest pain, upper-abdominal discomfort, nausea, or vomiting. Because standard radiographic studies may fail to detect small or atypically located defects, misdiagnosis is common and carries a risk of organ strangulation, obstruction, or cardiorespiratory compromise. Prompt recognition and definitive surgical management are therefore essential to optimize outcomes. CASE REPORT A 63-year-old man with end-stage renal disease secondary to diabetic nephropathy presented with a 2-day history of intermittent epigastric pain, nausea, and non-bilious vomiting. His only antecedent trauma was a motor vehicle collision 8 months earlier, which was managed conservatively. Contrast-enhanced computed tomography revealed a 5-cm defect in the central tendon of the diaphragm, with herniation of transverse colon and omental fat into the pericardial cavity. The patient underwent successful laparoscopic reduction of herniated contents and tension-free bridging repair using both biologic and composite synthetic mesh. The postoperative course was unremarkable. At 1-month follow-up, the patient remained asymptomatic. CONCLUSIONS This case underscores the importance of maintaining a high index of suspicion for DPH in patients with prior blunt trauma who present with unexplained thoracoabdominal symptoms, even months after injury. Laparoscopic mesh repair can achieve durable, tension-free closure with low morbidity, and should be considered the preferred approach when expertise and patient factors permit. A multidisciplinary care pathway is critical for optimizing perioperative management in high-risk populations.