blunt traumatic diaphragmatic rupture ( btdr ) is a life - threatening condition with an incidence of 0.8%1.6% in blunt trauma [ 13 ] .
the diagnosis often happens to be late due to the absence of typical symptoms or other major injuries dominating the clinical aspect .
an isolated btdr is rare and thus might be followed by a period of weeks or months not revealing any symptoms [ 2 , 5 ] .
most btdr are located on the left side in the musculotendinous intersection [ 1 , 3 , 4 ] .
herniation of colon , small bowel , or liver may occur and result in ileus , necrosis , and perforation [ 4 , 7 ] .
we present a rare case of a 68-year - old female hospitalized in the neurological department due to parkinson disease .
the examination showed a slightly reduced breath without any signs of pneumothorax or dyspnea , a decent pressure pain and a bruise .
the chest radiograph displayed a herniation of bowel into the right hemithorax with consecutive ileus signs ( figure 1 ) .  
we performed a laparoscopic approach and found a 4  5  cm rupture of the right diaphragm with herniation of 1 meter small bowel .
the transdiaphragmatic thoracoscopy displayed a collapsed lung and a dislocated rib fracture ( figure 2 ) .
after irrigation of the thoracic cavity we made a direct laparoscopic strainless running suture with nonabsorbable tie ( 0/0 ethibond ) .
the delay of the diagnosis was 4 days indicating the variety of the clinical appearance of the btdr .
the missing typical symptoms can mask the severity of the injury and lead to increasing morbidity . although large prospective long - term studies regarding outcome after laparoscopic approach are still missing , laparoscopy was the method of choice in our case and safely performed , particularly when severe side injuries are absent .  
we could show , that laparoscopy has advantages in isolated diaphragmatic ruptures compared to traditional laparotomy , which is still preferred by some authors [ 8 , 9 ] .
laparoscopy mostly allows easy reposition of herniated organs , sufficient inspection of the thoracic , and abdominal cavity and immediate laparotomy if necessary .
 blunt traumatic diaphragmatic rupture ( btdr ) is a life - threatening condition with an 
 incidence from 0,8%1,6% in blunt trauma , mostly located on the left side . 
 the main   prognostic factors are severe side injuries and the delay of diagnosis . 
 we present a rare case of a 68-year - old female , with an isolated right diaphragm rupture . 
 the diagnosis was done with a delay of 4 days by thoracic radiographs , which showed a   herniation of small bowel into the right thoracic cavity . 
 a reposition of the small bowel and a closure of the diaphragmatic defect by running suture were carried out 
 laparoscopicly . 
 although large prospective studies concerning the outcome of laparoscopic approach to right btdr are still missing , we could show , that laparoscopy can be performed safely in right traumatic diaphragm rupture . 
1. Introduction
2. Narrative
3. Discussion