Delayed Right Hemidiaphragm Rupture After Blunt Trauma Repaired With Prolene Mesh: A Case Report.

Traumatic diaphragmatic rupture (TDR) is a rare but serious injury. It most commonly results from high-impact blunt trauma. Right-sided ruptures are particularly uncommon due to the protective effect of the liver. Delayed presentation can cause diagnostic challenges, as the injury may remain clinically silent for years before complications such as organ herniation. We report a case of a 65-year-old male who presented with progressive dyspnea, right-sided chest pain, and right upper quadrant abdominal discomfort 4 years after a severe motor vehicle accident. Chest radiography revealed a heterogeneous opacity in the right hemithorax, and contrast-enhanced CT confirmed right hemidiaphragmatic rupture with intrathoracic herniation of the liver. The patient underwent urgent surgical repair. A large diaphragmatic defect was identified and repaired with a Prolene mesh in a tension-free fashion. The postoperative course was uneventful, with complete resolution of symptoms. This case highlights the importance of maintaining clinical suspicion for delayed diaphragmatic rupture in patients with a remote history of blunt trauma, even when initial imaging was normal. Contrast-enhanced CT remains the diagnostic standard, and Prolene mesh repair is a surgical solution for large diaphragmatic defects.