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Mancini A, Duramé A, Barbois S, Abba J, Ageron FX, Arvieux C. Relevance of early CT scan diagnosis of blunt diaphragmatic injury: A retrospective analysis from the Northern French Alps Emergency Network. J Visc Surg 2018; 156:3-9. [PMID: 30472050 DOI: 10.1016/j.jviscsurg.2018.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Diaphragmatic rupture following blunt trauma occurs rarely. Classically described after high-velocity accidents, ruptures are often associated with multiple organ injuries. The diagnosis is sometimes difficult. The goal of this study was to analyze and to discuss the modalities of early radiologic diagnosis and management of these injuries. PATIENTS AND METHODS This multicenter retrospective study included patients seen between 2009 and 2017 within the Northern Alpine Emergency Network [REseau Nord Alpin des Urgences (RENAU)]. Clinical, radiologic and surgical data from all patients sustaining blunt diaphragmatic rupture were studied. RESULTS Thirty-one patients (18 men and 13 women), median age 44, were included. The principle mechanism of injury was road or traffic accidents for 22 patients. Diaphragmatic rupture occurred on the left side in 23 patients. Diagnosis was delayed in two patients, at 11 days and three months after the initial accident. Chest X-rays were diagnostic in 18 of 29 patients. CT scan was the reference investigation since it was performed in all patients and confirmed the diagnosis in 26 instances. Repair was surgical via a midline laparotomy in 27 patients, via laparoscopy in three, and via thoracoscopy in one. Three patients died. CONCLUSION At urgent surgical exploration in the unstable blunt trauma patient, the surgeon should keep in mind the relatively poor diagnostic performance of chest X-rays. Accurate diagnosis relies on routine inspection of the diaphragmatic cupolas. In the stable trauma victim, contrast-enhanced abdomino-thoracic CT with reconstruction can lead to early diagnosis, which allows for repair under optimal conditions, whether by laparotomy, laparoscopy or thoracoscopy, according to local conditions and expertise.
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Affiliation(s)
- A Mancini
- Service de chirurgie digestive et de l'urgence, CHU Grenoble-Alpes, CS 102017, 38043 Grenoble cedex, France
| | - A Duramé
- Service de chirurgie digestive et de l'urgence, CHU Grenoble-Alpes, CS 102017, 38043 Grenoble cedex, France
| | - S Barbois
- Service de chirurgie digestive et de l'urgence, CHU Grenoble-Alpes, CS 102017, 38043 Grenoble cedex, France
| | - J Abba
- Service de chirurgie digestive et de l'urgence, CHU Grenoble-Alpes, CS 102017, 38043 Grenoble cedex, France
| | - F-X Ageron
- Urgences SAMU-SMUR, centre hospitalier Annecy-Genevois, 74370 Metz-Tessy, France
| | - C Arvieux
- Service de chirurgie digestive et de l'urgence, CHU Grenoble-Alpes, CS 102017, 38043 Grenoble cedex, France.
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Atoini F, Traibi A, Elkaoui H, Elouieriachi F, Elhammoumi M, Sair K, Kabiri EH. [Missed right post-traumatic diaphragmatic injuries: a review of six cases]. REVUE DE PNEUMOLOGIE CLINIQUE 2012; 68:185-193. [PMID: 22196082 DOI: 10.1016/j.pneumo.2011.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2009] [Revised: 06/15/2011] [Accepted: 07/17/2011] [Indexed: 05/31/2023]
Abstract
INTEREST Right posttraumatic diaphragmatic injuries are rare; literature relates mainly isolated cases or small series and most often rupture are succeeding of blunt trauma. This series is interesting because the number of cases and the existence of two injuries following a right stab wound. PATIENTS AND METHODS Retrospective study between January 2002 and September 2010. We collected the data of initial trauma, clinical, radiological, operative and follow-up for six patients supported for right posttraumatic diaphragmatic injuries. RESULTS All injuries were in late presentation. Four injuries were secondary to road traffic accident, and two after stab wound. The time to diagnosis was between 47 days and 15 years. Right posterolateral thoracotomy was the elective approach in the cases with diaphragmatic hernia (5 patients). In one case, video-assisted thoracoscopic surgery permits the diagnosis and repair of injury. Mortality was null and morbidity was present in one case from six. Follow-up ranging from 8 months and 42 months don't objectified complications. CONCLUSION Right diaphragmatic hernia is terrible sequelae after thoracoabdominal trauma. Surgery becomes more complex at this stage and can be done by thoracotomy. With strong suspicious signs at the first assessment of trauma, exploration by thoracoscopy can always avoid the occurrence of long-term sequelae.
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Affiliation(s)
- F Atoini
- Service de chirurgie thoracique, hôpital militaire d'instruction Mohammed V, Rabat, Maroc.
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Julien F, Drolet S, Lévesque I, Bouchard A. The right lateral position for laparoscopic diaphragmatic hernia repair in pregnancy: technique and review of the literature. J Laparoendosc Adv Surg Tech A 2011; 21:67-70. [PMID: 21314565 DOI: 10.1089/lap.2010.0461] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Maternal diaphragmatic hernia is a rare disorder of pregnancy. Laparoscopic repair of diaphragmatic hernias is gaining more and more consideration among the surgical community. To date, only a few centers have reported using the laparoscopic approach for diaphragmatic hernias occurring in pregnancy. As congenital diaphragmatic hernias occur mostly on the left side, a right lateral position would theoretically facilitate the surgery and would render an eventual simultaneous left thoracoscopy feasible without repositioning the patient. However, such a position in a pregnant woman has serious implications because of possible inferior vena cava compression by the gravid uterus. We performed a laparoscopic reduction and repair of a left foramen of Bochdalek hernia in a 26-week-pregnant patient, using a right lateral position. The right lateral position facilitated the procedure, without any adverse outcome for the fetus or the mother. This approach should be considered for any left diaphragmatic hernia repair occurring in pregnancy.
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Affiliation(s)
- François Julien
- Department of Surgery, Centre Hospitalier Universitaire de Québec, Québec, Canada
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4
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Naija W, Souii S, Chemchik H, Farhat I, Said R. [Traumatic rupture of aortic isthmus associated with left blunt diaphragmatic rupture discovered after 20 years of latency]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2011; 30:163-165. [PMID: 21277736 DOI: 10.1016/j.annfar.2010.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
MESH Headings
- Accidents, Traffic
- Aorta, Thoracic/injuries
- Aorta, Thoracic/surgery
- Hernia, Diaphragmatic, Traumatic/complications
- Hernia, Diaphragmatic, Traumatic/diagnostic imaging
- Hernia, Diaphragmatic, Traumatic/surgery
- Humans
- Magnetic Resonance Angiography
- Male
- Middle Aged
- Radiography, Thoracic
- Rupture
- Shock/etiology
- Shock/therapy
- Thoracotomy
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Boufettal R, Lefriyekh M, Boufettal H, Fadil A, Zerouali N. Rupture spontanée du diaphragme pendant l’accouchement. ACTA ACUST UNITED AC 2008; 37:93-6. [DOI: 10.1016/j.jgyn.2007.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Revised: 09/09/2007] [Accepted: 10/03/2007] [Indexed: 11/30/2022]
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Mahajna A, Mitkal S, Bahuth H, Krausz MM. Diagnostic laparoscopy for penetrating injuries in the thoracoabdominal region. Surg Endosc 2006; 18:1485-7. [PMID: 15791374 DOI: 10.1007/s00464-003-9296-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The role of laparoscopy in diagnosis of penetrating abdominal injuries is still controversial. In the present investigation diagnostic laparoscopy was studied in penetrating injuries of the thoracoabdominal region. METHODS Between March 1998 and June 2003, 43 patients with penetrating thoracoabdominal injuries underwent diagnostic laparoscopy at the Rambam Medical Center. There were 41 males and two females; the average age was 30 years (range, 16-54 years). Thirty-one patients had a lower chest injury, eight patients had an upper abdomen and flank injury, and four patients had combined chest and abdomen injuries. In 11 patients intraperitoneal penetration was diagnosed. In 10 patients the procedure was converted to open laparotomy, and one patient with a small laceration of the right diaphragm opposite the liver was observed without laparotomy. RESULTS The average operating time for the laparoscopy was 25 min (10-45 min), and 85 min (40-175 min) for laparotomy. Patients who underwent laparoscopy were discharged after an average of 1.6 (1-3) days, while those who underwent laparotomy were discharged after an average of 7.6 (2-15) days. CONCLUSIONS Laparoscopy is a useful diagnostic tool in penetrating injuries of the chest, thoracoabdominal region, and flank. This procedure is particularly reliable in diaphragmatic tears. Laparoscopy should be considered the procedure of choice for the evaluation of penetrating injuries of the lower chest and upper abdomen for diagnosis of peritoneal penetration.
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Affiliation(s)
- A Mahajna
- Department of Surgery A, and the Bruce Rappaport Faculty of Medicine, Rambam Medical Center, Technion-Israel Institute of Technology, POB 9602, Haifa 31096, Israel
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7
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Esquis P, Osmak L, Ognois P, Goudet P, Cougard P. [Thoracic kidney: congenital or traumatic origin?]. ANNALES DE CHIRURGIE 2005; 131:276-8. [PMID: 16297847 DOI: 10.1016/j.anchir.2005.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2005] [Accepted: 09/13/2005] [Indexed: 10/25/2022]
Abstract
The discovery of a thoracic kidney in adult patients can lead to three diagnoses, yielding different prognoses and treatment. It can either mean traumatic or congenital diaphragmatic hernia, or a congenital ectopic kidney. Intrathoracic herniation of the left kidney trough a left diaphragmatic rupture is an exceptional discovery. We report the case of a 44 year-old man who met with a car accident 20 years ago, and presented abdominal pain. CT-scan showed an intrathoracic herniation of the left kidney trough a left posterior diaphragmatic rupture. Laparoscopic approach in lateral position showed a traumatic hernia of the left costo-diaphragmatic hiatus only containing the left kidney and its pedicle. After reduction of herniated left kidney into the abdomen, the hiatus was closed by non-resorbable prosthetic mesh. Postoperative course was uneventful.
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Affiliation(s)
- P Esquis
- Service de Chirurgie Générale et Endocrinienne, CHU de Dijon, 3, rue Faubourg-Raines, 21000 Dijon, France.
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Thoman DS, Hui T, Phillips EH. Laparoscopic diaphragmatic hernia repair. Surg Endosc 2002; 16:1345-9. [PMID: 11984662 DOI: 10.1007/s00464-001-8162-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2001] [Accepted: 01/07/2002] [Indexed: 10/26/2022]
Abstract
BACKGROUND Adult-congenital diaphragmatic hernias and chronic traumatic diaphragmatic hernias are uncommon entities that are often technically challenging to repair. There is growing experience with a minimal access approach to these defects. METHODS We reviewed the English-language literature using a MEDLINE search for "diaphragmatic hernia" and "laparoscopy." RESULTS We found 19 case reports of laparoscopic adult-congenital diaphragmatic hernia repair. Reported complications included two enterotomies, one of which required conversion to laparotomy. We also found 11 case reports of laparoscopic chronic traumatic diaphragmatic hernia repair, with no reported complications or recurrences. Average operative time was 98 min, and average length of stay was 4.5 days. All reports claimed that there was less postoperative pain and an earlier return to full activity with the laparoscopic approach. Herein we discuss anatomy, pathophysiology, diagnosis, method of repair, and recurrence. CONCLUSION Adult-congenital diaphragmatic hernia and chronic traumatic diaphragmatic hernia are amenable to laparoscopic repair. Although experience is still limited, laparoscopic repair appears safe and is associated with a shorter hospital stay.
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Affiliation(s)
- D S Thoman
- Division of Minimally Invasive Surgery, Cedars-Sinai Medical Centre, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
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Repair of a Diaphragmatic Injury During Hand Assisted Laparoscopic Nephrectomy Using an Onlay Patch of Polypropylene and Polyglactin Mesh. J Urol 2002. [DOI: 10.1097/00005392-200206000-00037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Repair of a Diaphragmatic Injury During Hand Assisted Laparoscopic Nephrectomy Using an Onlay Patch of Polypropylene and Polyglactin Mesh. J Urol 2002. [DOI: 10.1016/s0022-5347(05)65016-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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12
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Hüttl TP, Lang R, Meyer G. Long-term results after laparoscopic repair of traumatic diaphragmatic hernias. THE JOURNAL OF TRAUMA 2002; 52:562-6. [PMID: 11901338 DOI: 10.1097/00005373-200203000-00026] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Thomas P Hüttl
- Department of Surgery, Klinikum Grosshadern, University of Munich, Munich, Germany.
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Duverger V, Saliou C, Lê P, Chatel D, Johanet H, Acar C, Gigou F, Laurian C. [Blunt force rupture of the thoracic aorta and diaphragm: an unusual association]. ANNALES DE CHIRURGIE 2001; 126:339-45. [PMID: 11413815 DOI: 10.1016/s0003-3944(01)00522-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this study was to report two cases of rupture of the right hemidiaphragm with intra-thoracic liver hernia, associated with a traumatic aortic disruption. These two lesions followed traffic accidents, and were both treated separately. Both patients had a long-term favourable progression. Association of these two lesions is particularly rare: fewer than 50 cases have been previously described in an extensive review of the literature. CT-scan seems to be particularly efficient in diagnosis, even if less efficient than other more specific explorations. The order of surgical management is guided by the physical examination, and especially by abdominal emergency.
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Affiliation(s)
- V Duverger
- Service de chirurgie vasculaire, hôpital d'instruction des armées Begin, 69, avenue de Paris, 94160 Saint-Mandé, France
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