1
|
Alfardan N, Fernandes R, Thomas J. Right-sided diaphragmatic hernia causing gastric outlet obstruction 1 month after trauma. BMJ Case Rep 2024; 17:e255767. [PMID: 38383121 PMCID: PMC10882446 DOI: 10.1136/bcr-2023-255767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
Diaphragmatic hernias arising from trauma are rare, and scarcely present in a delayed manner. This case report highlights a case of delayed presentation of a right-sided post-traumatic hernia in a woman in her early 70s following a fall. The aim of this report is to shed light on the diagnostic peculiarities and management. The woman presented with a 3-day history of abdominal pain and coffee-ground vomiting. This followed a fall a month ago. CT confirmed the diagnosis of a gastric outlet obstruction secondary to a right-sided diaphragmatic rupture. At surgery, the herniated abdominal contents were reduced, and the diaphragmatic defect was fixed. The postoperative recovery was unremarkable, and the patient was discharged on day 4. This case highlights that diaphragmatic hernias should be considered as differential diagnoses following recent trauma.
Collapse
Affiliation(s)
- Nadya Alfardan
- East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - Roland Fernandes
- General Surgery, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - Janine Thomas
- East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| |
Collapse
|
2
|
Pace M, Vallati D, Belloni E, Cavallini M, Ibrahim M, Rendina EA, Nigri G. Blunt Trauma Associated With Bilateral Diaphragmatic Rupture: A Case Report. Front Surg 2021; 8:772913. [PMID: 34926569 PMCID: PMC8671305 DOI: 10.3389/fsurg.2021.772913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background: A bilateral diaphragmatic rupture is a rare event that occurs in cases of blunt thoracic-abdominal trauma. Case Presentation: We report the case of a 56-year-old female patient with pelvic fracture and second-stage bilateral rupture of the diaphragm due to a car accident. After a chest and abdominal contrast-enhanced computed tomography (CT) scan, the patient underwent emergency suturing of the left hemidiaphragm. On postoperative day (POD) 4, a CT scan performed due to the sudden onset of dyspnea revealed rupture of the right hemidiaphragm, which was not detected on the preoperative CT scan. On POD 9, the right hemidiaphragm was repaired with mesh during a right thoracotomy. The patient recovered 14 days after surgery. However, the postoperative course was complicated by an asymptomatic COVID-19 infection that significantly delayed her discharge from the hospital. Conclusions: Difficulties in preoperative diagnosis and treatment, together with the lack of data in the literature, make this type of trauma a challenge for all acute care and general surgeons.
Collapse
Affiliation(s)
- Marco Pace
- General Surgery Unit, Department of Medical and Surgical Sciences and Translational Medicine, St. Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Damiano Vallati
- General Surgery Unit, Department of Medical and Surgical Sciences and Translational Medicine, St. Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Elena Belloni
- General Surgery Unit, Department of Medical and Surgical Sciences and Translational Medicine, St. Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Marco Cavallini
- General Surgery Unit, Department of Medical and Surgical Sciences and Translational Medicine, St. Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Mohsen Ibrahim
- Thoracic Surgery Unit, Department of Medical and Surgical Sciences and Translational Medicine, St. Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Erino Angelo Rendina
- Thoracic Surgery Unit, Department of Medical and Surgical Sciences and Translational Medicine, St. Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Nigri
- General Surgery Unit, Department of Medical and Surgical Sciences and Translational Medicine, St. Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
3
|
Agarwal N, Dokania MK, Kumar GR, Manda DG, Singh Rana AK. Significant Liver Atrophy Due to Vascular Compromise Associated With Adult Congenital Diaphragmatic Hernia. Cureus 2021; 13:e17158. [PMID: 34548972 PMCID: PMC8437081 DOI: 10.7759/cureus.17158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 11/30/2022] Open
Abstract
Diaphragmatic hernia in adults is mostly post-traumatic in origin, and rarely congenital. In both situations, the right side is less commonly involved due to the protection offered by the liver and earlier closure of the right pleuroperitoneal canal. A congenital diaphragmatic hernia may present in adulthood with multi-visceral contents, of which the liver is an extremely rare content, mentioned only in a few previous reports. A herniated liver may mimic a pulmonary tumor and may be completely atrophic due to sustained compression of the venous outflow. Careful operative planning is essential to identify and reduce the liver, along with other contents. We are reporting two adults with a congenital diaphragmatic hernia, with multi-visceral contents and an atrophied liver. The first patient was a 28-year-old man with a remote history of trauma found to have a large right diaphragmatic hernia on imaging. The right liver was completely atrophied due to right hepatic venous compression, while the left liver underwent massive hypertrophy and rotation of the left portal axis. Exploratory laparotomy and reduction of contents, along with mesh repair, were accomplished with satisfactory results. The second patient was a 26-year-old man with Down’s syndrome detected to have multiple bowel loops in the right thorax on imaging. At laparoscopy, a Larrey’s type of Morgagni hernia with a right paramedian defect was found. The left liver was atrophied into a leaf-like appendage due to possible portal obliteration and was dissected away from the diaphragm edge. Appropriate mesh repair was completed by a minimally invasive technique.
Collapse
Affiliation(s)
- Nitin Agarwal
- Transplant Unit, Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital (RMLH), Delhi, IND
| | - Manoj K Dokania
- Transplant Unit, Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital (RMLH), Delhi, IND
| | - Gyan R Kumar
- Transplant Unit, Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital (RMLH), Delhi, IND
| | - Dharmateja G Manda
- Transplant Unit, Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital (RMLH), Delhi, IND
| | - Anil K Singh Rana
- Transplant Unit, Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital (RMLH), Delhi, IND
| |
Collapse
|
4
|
Magyar M, Glasz T, Kovács T, Deák AB, Maurovich-Horvat P, Futácsi B. Liver displacement caused by distended stomach in Parkinsonian patient. IMAGING 2021. [DOI: 10.1556/1647.2021.00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
AbstractGastroparesis, a form of gastrointestinal dysfunction and the increased risk for aspiration pneumonia are well known complications in patients with Parkinson’s disease. In our case report we demonstrate the case of an 83-year-old, bedridden male patient with Parkinson’s disease, who had a slowly progressing stomach dilation, gradually pushing the otherwise normal liver to a highly unusual craniodorsally rotated position.
Collapse
Affiliation(s)
- Máté Magyar
- Department of Neuroradiology, Faculty of Medicine, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Tibor Glasz
- 2nd Department of Pathology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Tekla Kovács
- 2nd Department of Pathology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - András Bálint Deák
- 2nd Department of Pathology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Pál Maurovich-Horvat
- Department of Radiology, Faculty of Medicine, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Balázs Futácsi
- Department of Radiology, Faculty of Medicine, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| |
Collapse
|
5
|
Lugarinho-Monteiro MTRV, Pereira L, Seco C. Chronic hepatothorax due to right diaphragmatic rupture: an anesthetic challenge in a rare case. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2018. [PMID: 27005827 PMCID: PMC9391749 DOI: 10.1016/j.bjane.2015.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Diaphragmatic rupture is an uncommon condition, with 90% of ruptures occurring on the left side. However, its incidence on the right side is increasing along with the increase in traffic accidents. Liver herniation may become progressive causing severe atelectasis of the right lung, resulting in impaired respiratory status and hemodynamic changes. Case report We report the case of a 40 years old female, ASA III, scheduled for hepatothorax repair that evolved from right diaphragmatic hernia after a car accident when she was 8 years old. Clinically, she had severe restrictive respiratory syndrome caused by the hepatothorax. The anesthetic evaluation was normal, except for the chest X-ray showing elevation of the dome of the right hemidiaphragm without tracheal deviation. Diagnosis was confirmed by CT scan. After liver replacement in the abdominal cavity, a transient increase in central venous pressure, stroke volume index and flow time corrected (35%), and a decrease in systemic vascular resistance were observed. After complete hemodynamic and hepatosplenic stabilization, as well as ventilation, the patient was transferred intubated, under controlled ventilation and monitored, to the liver transplant unit. Conclusions Hepatothorax is a rare condition and its repair may represent an anesthetic challenge. After liver replacement in the abdominal cavity during corrective surgery under general anesthesia complications may occur, particularly associated with pulmonary re-expansion. Effective teamwork and careful planning of surgery, between the surgical and anesthetic teams, are the key to success.
Collapse
|
6
|
Sala C, Bonaldi M, Mariani P, Tagliabue F, Novellino L. Right post-traumatic diaphragmatic hernia with liver and intestinal dislocation. J Surg Case Rep 2017; 2017:rjw220. [PMID: 28458842 PMCID: PMC5400456 DOI: 10.1093/jscr/rjw220] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 11/28/2016] [Accepted: 03/08/2017] [Indexed: 12/02/2022] Open
Abstract
Right diaphragmatic hernia is an uncommon injury following abdominal trauma. A case of delayed right post-traumatic diaphragmatic hernia is presented. The patient referred us with wheezing and cough since 1 month. A chest-abdominal computed tomography scan demonstrated a large diaphragmatic defect with liver and intestinal dislocation. The patient underwent surgical intervention with diaphragmatic repair. No complications were observed during admission and follow-up is actually negative for recurrence.
Collapse
Affiliation(s)
- C Sala
- General Surgery Post-Graduation School, University of Milan, Milano, Italy
| | - M Bonaldi
- General Surgery Post-Graduation School, University of Milan, Milano, Italy
| | - P Mariani
- Unit of General Surgery, Department of Minimally Invasive and General Surgery, Azienda Ospedaliera Bolognini, Seriate,Bergamo, Italy
| | - F Tagliabue
- Unit of General Surgery, Department of Minimally Invasive and General Surgery, Azienda Ospedaliera Bolognini, Seriate,Bergamo, Italy
| | - L Novellino
- Unit of General Surgery, Department of Minimally Invasive and General Surgery, Azienda Ospedaliera Bolognini, Seriate,Bergamo, Italy
| |
Collapse
|
7
|
[Chronic hepatothorax due to right diaphragmatic rupture: an anesthetic challenge in a rare case]. Rev Bras Anestesiol 2016; 68:190-193. [PMID: 27005827 DOI: 10.1016/j.bjan.2016.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/17/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Diaphragmatic rupture is an uncommon condition, with 90% of ruptures occurring on the left side. However, its incidence on the right side is increasing along with the increase in traffic accidents. Liver herniation may become progressive causing severe atelectasis of the right lung, resulting in impaired respiratory status and hemodynamic changes. CASE REPORT We report the case of a 40 years old female, ASA III, scheduled for hepatothorax repair that evolved from right diaphragmatic hernia after a car accident when she was 8 years old. Clinically, she had severe restrictive respiratory syndrome caused by the hepatothorax. The anesthetic evaluation was normal, except for the chest X-ray showing elevation of the dome of the right hemidiaphragm without tracheal deviation. Diagnosis was confirmed by CT scan. After liver replacement in the abdominal cavity, a transient increase in central venous pressure, stroke volume index and flow time corrected (35%), and a decrease in systemic vascular resistance were observed. After complete hemodynamic and hepatosplenic stabilization, as well as ventilation, the patient was transferred intubated, under controlled ventilation and monitored, to the liver transplant unit. CONCLUSIONS Hepatothorax is a rare condition and its repair may represent an anesthetic challenge. After liver replacement in the abdominal cavity during corrective surgery under general anesthesia complications may occur, particularly associated with pulmonary re-expansion. Effective teamwork and careful planning of surgery, between the surgical and anesthetic teams, are the key to success.
Collapse
|
8
|
Tahiri LL, Tahiri A, Bajrami R, Hasimja S, Hasani A. Intrathoracal cholecystitis calculosa in a right-sided posttraumatic diaphragmatic hernia: a case report. J Med Case Rep 2013; 7:89. [PMID: 23548136 PMCID: PMC3623763 DOI: 10.1186/1752-1947-7-89] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 02/21/2013] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Injuries of the diaphragm were first described in 1541 by Sennertus and the initial repair was performed by Riolfi in 1886. Posttraumatic diaphragmatic hernia in adults is usually caused by blunt trauma and may remain asymptomatic and undiagnosed for many years. Right-sided tears are significantly less likely than left-sided tears because of the protective effect of the liver. They are associated with high mortality and morbidity. The rupture of the right side of the diaphragm and the presence of an inflamed gallbladder in the thoracic cavity are uncommon. CASE PRESENTATION We present the case of a 57-year-old Albanian man with prolapses of his gallbladder and other abdominal organs into the thoracic cavity through the herniation of his right hemidiaphragm due to trauma. The diaphragmatic hernia and gallstones seen in the thorax computed tomography scan were diagnostic. The organs herniated to the thoracic cavity were placed back into the abdominal cavity, a cholecystectomy was performed and the defect in the diaphragm was repaired with a prolene mesh graft during the operation. The patient was discharged 10 days after the surgical procedure, and no complications were reported. CONCLUSION Diaphragmatic hernia should be considered as a possible diagnosis in patients with respiratory disorders or unusual shadows in the thoracic region after recently sustained injury or with a history of injury. The prolapse of a gallbladder is rare. The symptoms are uncharacteristic and patients with this disease may remain without symptoms for a long period. Treatment is surgical.
Collapse
Affiliation(s)
- Laura L Tahiri
- University Clinical Center of Kosova, Clinic of Surgery, Rrethi i Spitalit pn, Prishtina, 10000, Republic of Kosova.
| | | | | | | | | |
Collapse
|
9
|
Ho MP, Wu YH, Tsai KC, Wu JM, Cheung WK. Delayed herniation of intra-abdominal contents after blunt right-sided diaphragm rupture. Am J Emerg Med 2012; 30:2089.e1-3. [DOI: 10.1016/j.ajem.2011.12.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Accepted: 12/13/2011] [Indexed: 11/29/2022] Open
|
10
|
Pulido J, Reitz S, Gozdanovic S, Price P. Laparoscopic repair of chronic traumatic diaphragmatic hernia using biologic mesh with cholecystectomy for intrathoracic gallbladder. JSLS 2012; 15:546-9. [PMID: 22643514 PMCID: PMC3340968 DOI: 10.4293/108680811x13176785204472] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
This report of an atypical cause of bowel obstruction suggests that laparoscopic intervention may be successfully used in the diagnosis and treatment of traumatic diaphragmatic hernia. Background and Objectives: Diaphragmatic rupture is a serious complication of both blunt and penetrating abdominal trauma. In the acute setting, delay in diagnosis can lead to severe cardiovascular and respiratory compromise. Chronic cases can present years later with a plethora of clinical symptoms. Laparoscopic techniques are being increasingly utilized in the diagnosis and treatment of traumatic diaphragmatic hernias. Method: We describe a case of a 70-year-old female who presented with signs and symptoms of a small bowel obstruction. She was ultimately found to have an obstruction secondary to a chronic traumatic diaphragmatic hernia with an intrathoracic gallbladder and incarcerated small intestine. A cholecystectomy and diaphragmatic hernia repair were both performed laparoscopically. This case report presents an atypical cause of bowel obstruction and reviews the current literature on laparoscopic management of traumatic diaphragmatic hernias. Results and Conclusion: Laparoscopy is increasingly used in the diagnosis and treatment of traumatic diaphragmatic hernias with good results.
Collapse
|
11
|
Laparoscopic repair of intrathoracic liver herniation after traumatic rupture of the diaphragm. Surg Endosc 2011; 25:3423-5. [DOI: 10.1007/s00464-011-1721-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 03/17/2011] [Indexed: 11/26/2022]
|
12
|
Puri V, van Berkel V, Krupnick AS, Kreisel D. Delayed presentation of traumatic diaphragmatic hernia. Hernia 2010; 14:447-8. [PMID: 20431902 DOI: 10.1007/s10029-010-0662-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Accepted: 04/09/2010] [Indexed: 10/19/2022]
|
13
|
Hoffmann B, Nguyen H, Hill HF. Diaphragmatic laceration after penetrating trauma: direct visualization and indirect findings on focused assessment with sonography for trauma in the emergency department. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:1259-1263. [PMID: 19710226 DOI: 10.7863/jum.2009.28.9.1259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Beatrice Hoffmann
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD 21224, USA.
| | | | | |
Collapse
|
14
|
Hepatothorax after right-sided diaphragmatic rupture mimicking a pleural effusion: a case report. CASES JOURNAL 2009; 2:8545. [PMID: 19830080 PMCID: PMC2740128 DOI: 10.4076/1757-1626-2-8545] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Accepted: 06/19/2009] [Indexed: 11/08/2022]
Abstract
Introduction Diaphragmatic ruptures are a rare condition with an incidence of about 0.8-5.8% after blunt thoracoabdominal trauma. Right sided ruptures accompanied by a displacement of intraabdominal organs are very uncommon and account for approximately 5-19% of all diaphragmatic ruptures. The majority of diaphragmatic ruptures are based on high speed motor vehicle accidents (MVA) and high falls. Case presentation Herein we report a case of a 58-year old woman after a high-speed MVA with a right-sided diaphragmatic rupture and displacement of the liver into the thorax, mimicking a pleural effusion. Conclusion Due to the low incidence and frequently present masking injuries, diagnosis is difficult and virtually always delayed. Thus, a high index of suspicion is important in cases of blunt thoracoabdominal trauma, as the 24 h mortality-rate of a right sided diaphragmatic rupture is up to 30%. In these situations a spiral CT-scan is the diagnostic tool of choice. Surgical intervention using an abdominal approach via a hockey-stick shaped incision is necessary even for small tears. Part of the polytrauma management following high speed MVAs is a critical review of the radiologic imaging.
Collapse
|
15
|
Late presentation of blunt right diaphragmatic rupture (hepatic hernia). Am J Emerg Med 2008; 26:638.e3-5. [DOI: 10.1016/j.ajem.2007.10.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Accepted: 10/24/2007] [Indexed: 11/22/2022] Open
|