A review of the patient’s old notes revealed that at the time of the injury the spleen was removed surgically, but it was not appreciated that there was a small rupture of the dome of the left hemidiaphragm. The patient gradually developed a hernia through which bowel could enter, producing the “hump” on the diaphragm seen on the chest radiograph.
Because this injury occurred many years ago and the patient has been asymptomatic, it is unlikely that the patient will come to any harm and was discharged.