[Intrathoracic displacement of the transverse colon as a late complication after abdominal knife stab wound. A case report].

The treatment of stab wounds of the abdomen is discussed controversely. The management of these wounds depends on a high degree on the clinical situation of the patient. Repeated physical examination, peritoneal lavage and laparotomy are recommended. The identification of an isolated diaphragmatic injury is worrisome because its subtle clinical presentation is often not alleviated by adjunctive tests. Delayed recognition of an incarcerated diaphragmatic hernia has a high mortality rate. We report about an 23 year old African male, who was injured by an intraabdominal stab wound. Initially he did not have any clinical problems, but after 6 months he was admitted to the hospital due to severe pulmonary complications. A diaphragmatic hernia with dislocation of the transverse colon into the left thorax was identified on x-rays. A thoracotomy as well as a laparotomy were performed to restore the anatomic conditions and to dose the hernia. After two weeks, the patient could leave the hospital without pulmonary complications. Under consideration of the literature we recommend exploratory laparotomy for stab wounds that penetrate the left side of the chest below the fourth intercostal space anteriorly, the sixth intercostal space laterally and the tip of the scapula posteriorly. The high mortality rate after a delayed recognition appears to justify an early operative approach.