The delayed presentation of traumatic diaphragmatic hernia is associated with high morbidity and mortality. Acute colobronchial fistula complicating delayed presentation of traumatic diaphragmatic hernia is previously unreported. A 52-year-old woman presented with a 4-day history of dyspnoea, feculent sputum and chest and abdominal pain 3 months after a road traffic accident. The diagnosis of Chilaiditi's syndrome, diaphragmatic hernia and colobronchial fistula was confirmed with computed tomography (CT) and treated by chest drain, primary hernia repair and right hemicolectomy. Spontaneous decompression through the bronchus had prevented tension fecopneumathorax. The diagnosis of diaphragmatic hernia is difficult but delay is associated with increased mortality. Symptoms include dyspnoea, chest and abdominal pain, with decreased respiratory sounds and visceral sounds in the thorax. Abdominal visceral structures or gas on CXR, CT or contrast studies will confirm the diagnosis. The initial operative approach is laparotomy but thoracotomy must be considered as abdominal viscera may be adherent to thoracic structures. Urban & Vogel.
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