Tension faecopneumothorax: an analysis of a rare complication of a missed diaphragmatic injury.

<b>Introduction:</b> Tension faecopneumothorax (TFP) is a rare but potentially lethal complication of missed diaphragmatic injuries, wherein the herniated intestine perforates, releasing gas and faeces-contaminated fluids in the pleural cavity. This leads to an increase in the intrapleural pressure to levels that exceed the atmospheric pressure and results in adverse effects, which include mediastinal shift, kinking of the great vessels, reduced venous return, and cardiovascular collapse. <br><br><b>Aim:</b> This article was composed to review the profile of the cases of tension faecopneumothorax arising as a complication of missed diaphragmatic injuries, as reported in the recent literature. <br><br><b>Materials and methods:</b> A systematic literature search was conducted through electronic databases, including PubMed, Scopus, and Google Scholar, using the keywords and terms 'tension faecopneumothorax ', 'delayed diaphragmatic rupture', 'missed diaphragmatic injury', 'delayed tension faecopneumothorax', and 'traumatic diaphragmatic herniation'. Only literature in English was considered for inclusion in this study, and the time frame of 20 years was fixed between 2004 and 2024. <br><br><b>Results:</b> A total of 12 cases with a mean age of 45.2 years were included in the review. Abdominal pain, respiratory distress, and hemodynamic instability were the major presenting clinical features, manifesting acutely or gradually with sudden deterioration. All the hernias were left-sided and herniation of transverse colon was found in 11 (91.7%) cases. All the cases were managed by laparotomy with or without thoracotomy. There was one mortality and intensive care for variable periods was required in 4 (33.3%) cases. <br><br><b>Conclusions:</b> Tension faecopneumothorax is a rare and potentially lethal complication of missed diaphragmatic injuries that may appear even after years of trauma. This condition needs to be considered as a possible differential diagnosis, when a patient of sudden onset respiratory distress is being evaluated, particularly if there is a past history of blunt or penetrating abdominothoracic trauma.