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Gillaspie D, Gillaspie EA. Management of Traumatic Diaphragmatic Injuries. Thorac Surg Clin 2024; 34:171-178. [PMID: 38705665 DOI: 10.1016/j.thorsurg.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Diaphragm injuries are rarely seen injuries in trauma patients and are difficult to diagnose. With improving technology, computed tomography has become more reliable, but with increasing rates of non-operative management of both penetrating and blunt trauma, the rate of missed diaphragmatic injury has increased. The long-term complications of missed injury include bowel obstruction and perforation, which can carry a mortality rate as high as 85%. When diagnosed, injuries should be repaired to reduce the risk of future complications.
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Affiliation(s)
- Devin Gillaspie
- Division of Acute Care Surgery, Department of Surgery, University of Tennessee Medical Center Knoxville, 1924 Alcoa Highway Box U-11, Knoxville, TN 37920, USA.
| | - Erin A Gillaspie
- Division of thoracic Surgery, Creighton University Medical Center CHI Health, 7500 Mercy Road, Omaha, NE 68124, USA
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Alfaraj D, Alwatyan KI, Al Ashour MH, Alghamdi FA, Alhowaish AA. A Case of Traumatic Diaphragm Rupture: A Differential Diagnosis Not to Be Missed. Cureus 2023; 15:e49820. [PMID: 38164299 PMCID: PMC10758220 DOI: 10.7759/cureus.49820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2023] [Indexed: 01/03/2024] Open
Abstract
Traumatic diaphragmatic rupture is a rare condition with clinical stigmata that overlaps with a similarly fatal condition such as tension pneumothorax. Although the former is much rarer, early differentiation between a ruptured diaphragm and a tension pneumothorax is crucial to avoid incorrect interventions. In this case, we present a middle-aged male construction worker who fell from the roof of a two-story building and presented to our emergency department with a clinical presentation similar to that of tension pneumothorax. However, a chest X-ray later revealed a left diaphragmatic hernia, which completely altered the management. This case helps highlight the importance of widening one's list of differential diagnoses, especially in the setting of a hectic environment and a vague presentation.
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Affiliation(s)
- Dunya Alfaraj
- Emergency Medicine, Imam Abdulrahman Bin Faisal University, King Fahad University Hospital, Dammam, SAU
| | - Khaleel I Alwatyan
- Medicine, Imam Abdulrahman Bin Faisal University, King Fahad University Hospital, Dammam, SAU
| | - Mustafa H Al Ashour
- Medicine, Imam Abdulrahman Bin Faisal University, King Fahad University Hospital, Dammam, SAU
| | - Faisal A Alghamdi
- Medicine, Imam Abdulrahman Bin Faisal University, King Fahad University Hospital, Dammam, SAU
| | - Abdullah A Alhowaish
- Medicine, Imam Abdulrahman Bin Faisal University, King Fahad University Hospital, Dammam, SAU
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Al Babtain I, AlObaid B, Alsogair R, Aljrayed MA, Almohaisen G, Al-Mutairi A. Incidence of Traumatic Diaphragmatic Injury: Results From a Retrospective Cohort Study in a Level I Trauma Center in Riyadh. Cureus 2023; 15:e47215. [PMID: 38022168 PMCID: PMC10653265 DOI: 10.7759/cureus.47215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Traumatic diaphragmatic injuries (TDIs) are uncommon and the incidence of TDI is difficult to estimate because of the variation in reporting missed or late detected diaphragmatic injuries. Therefore, our study's aim was to investigate the prevalence of traumatic diaphragmatic injury in the thoracoabdominal trauma, discuss the etiological factors, diagnostic investigations, and outcomes in TDIs, and evaluate predictors of mortality in patients who were diagnosed at King Abdulaziz Medical City in Riyadh, Saudi Arabia. Materials and methods This observational retrospective cohort study was conducted at King Abdulaziz Medical City (KAMC), a tertiary hospital in Riyadh, Saudi Arabia. The study included all adult patients aged 18 years or older diagnosed with traumatic diaphragmatic injuries between the years 2016 and 2020. The BESTCare electronic system was used to get the patient's medical records and extract the data. Pearson χ2 test was used for categorical variables, and an independent t-test was used for continuous variables to investigate the association between predictors and outcomes. Results A total of eight patients were involved in this study. The mean age of the patients was 49 years old. Males outnumbered females by 75%. Patients admitted with blunt injuries were greater by 75% compared to penetrating injuries by 25%. The left side of the diaphragm was the most common site of injury. The total number of patients who were admitted to the ICU was five, four of whom had blunt trauma and one had a penetrating injury. Conclusion The demographic data of the patients included in this study corresponded to that in the literature. Although not reaching a statistically significant level, ICU admissions and mortality were mostly associated with blunt injuries. Larger multi-center studies are required to further investigate the incidence of traumatic diaphragmatic injuries (TDI).
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Affiliation(s)
| | - Bashayer AlObaid
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Reema Alsogair
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Maha A Aljrayed
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Ghadi Almohaisen
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Abrar Al-Mutairi
- College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
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Shrestha O, Basukala S, Karki S, Thapa N, Joshi N, Shrestha L, Shrestha M. Diaphragmatic rupture secondary to trauma from falling sacks: A case report. Clin Case Rep 2023; 11:e7427. [PMID: 37255616 PMCID: PMC10225611 DOI: 10.1002/ccr3.7427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/13/2023] [Accepted: 05/16/2023] [Indexed: 06/01/2023] Open
Abstract
Key Clinical Message Diaphragmatic hernia does not only occur during high velocity impact or penetrating injury, but also can occur when heavy loads impact the torso. Diaphragmatic hernia must be ruled out in a patient with polytrauma with a chest X-ray at the least. Abstract Trauma-induced diaphragmatic hernia is a protrusion of abdominal contents through the defect in diaphragm and is an uncommon and less heard of injury. This case report conveys that diaphragmatic hernia should be ruled out in any polytrauma case presenting with shortness of breath with the chest X-ray at the least.
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Affiliation(s)
- Oshan Shrestha
- College of MedicineNepalese Army Institute of Health SciencesKathmanduNepal
| | - Sunil Basukala
- Department of SurgeryNepalese Army Institute of Health SciencesKathmanduNepal
| | - Sagun Karki
- College of MedicineNepalese Army Institute of Health SciencesKathmanduNepal
| | - Niranjan Thapa
- College of MedicineNepalese Army Institute of Health SciencesKathmanduNepal
| | - Niraj Joshi
- College of MedicineNepalese Army Institute of Health SciencesKathmanduNepal
| | - Lochan Shrestha
- Department of SurgeryNepalese Army Institute of Health SciencesKathmanduNepal
| | - Melina Shrestha
- Department of SurgeryNepalese Army Institute of Health SciencesKathmanduNepal
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Chellasamy RT, Rajarajan N, Pio Samy NM, Munusamy H. A Rare Case of Traumatic Pericardio-Diaphragmatic Injury Following a Road Traffic Accident. Cureus 2023; 15:e39125. [PMID: 37332455 PMCID: PMC10273778 DOI: 10.7759/cureus.39125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
Traumatic pericardi0-diaphragmatic rupture is very rare. It occurs due to high-velocity blunt trauma or penetrating injury to the abdomen or chest, which requires emergency intervention. The severity of injury varies, and it is very difficult to diagnose. Diaphragmatic ruptures are more common on the left side. Pericardial tears and diaphragmatic rupture are rare and often unrecognized in the acute phase. Computed Tomography is essential to diagnose and requires emergency surgery to avoid dreaded complications. A twenty-eight-year-old female reported to the emergency department with blunt injury to the abdomen following a road traffic accident. She was found to have diaphragmatic and a pericardial rupture with herniation of the bowel into the thoracic cavity. Emergency surgical repair was done. We report this case, as it is very rare to have a pericardial involvement along with diaphragmatic rupture, and to elaborate on the technical aspect of the surgical repair.
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Affiliation(s)
- Rajeev Thilak Chellasamy
- Cardiac/Thoracic/Vascular Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, IND
| | - Nembian Rajarajan
- Cardiac/Thoracic/Vascular Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, IND
| | - Noel Marie Pio Samy
- Anaesthesiology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, IND
| | - Hemachandren Munusamy
- Cardiac/Thoracic/Vascular Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, IND
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Guo J, Putri NE. Spontaneous diaphragmatic rupture in a young gentleman presenting with back pain. ANZ J Surg 2023; 93:724-726. [PMID: 35861356 DOI: 10.1111/ans.17932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/13/2022] [Accepted: 07/13/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Jiwei Guo
- Department of General Surgery, Singapore General Hospital, Singapore
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Kori M, Endo H, Yamamoto K, Awano N, Takehana T. Laparoscopic repair and total gastrectomy for delayed traumatic diaphragmatic hernia complicated by intrathoracic gastric perforation with tension empyema: a case report. Surg Case Rep 2022; 8:117. [PMID: 35718811 PMCID: PMC9207163 DOI: 10.1186/s40792-022-01477-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background Blunt traumatic diaphragmatic hernia (TDH) is a complication of blunt diaphragmatic injury. If missed, it could lead to critical presentations, such as incarceration or strangulation of the herniated intra-abdominal organs, and thus, early surgical repair is required. Methods of the operative approach against delayed TDH remain unclear. Even with the spread of the minimally invasive approach, laparotomy has been predominantly selected for cases with hemodynamic or gastrointestinal complaints. Literature on the use of laparoscopy for repair of such cases is limited, and no study has been conducted for those with intrathoracic gastric perforation. Case presentation A 55-year-old male patient with a history of multiple traumas presented with shock, followed by left hypochondrium pain and vomiting. The patient was admitted to the emergency department of our institution and diagnosed with delayed TDH complicated by intrathoracic gastric perforation, and tension empyema. Emergency surgery using laparoscopic approach was performed, despite unstable hemodynamics, considering orientation, exposure, and operativity compared with laparotomy. Repair of the diaphragm plus total gastrectomy was successfully performed by minimally invasive management. The patient made an uneventful recovery without recurrence after 8 months. Conclusion Unstable hemodynamic conditions and intrathoracic gastric perforation could not be contraindications to laparoscopic repair in treating delayed TDH.
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van Wyk C, Hlaise KK, Blumenthal R. Traumatic Diaphragmatic Injuries at Medicolegal Autopsy: A 1-Year Prospective Study. Am J Forensic Med Pathol 2022; 43:347-353. [PMID: 35970516 DOI: 10.1097/paf.0000000000000788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Traumatic diaphragmatic injuries (TDIs) are relatively rare. The forensic literature pertaining to TDIs consists mainly of case studies, suggesting little attention to these injuries during autopsies and research. MATERIALS AND METHODS This prospective study was conducted at the Ga-Rankuwa Forensic Pathology Services mortuary over a 1-year period. We included all cases who had a full medicolegal autopsy, as prescribed by the relevant South African legislation (Inquest Act 58 of 1959). All diaphragms were examined by a forensic medical practitioner performing the autopsy. RESULTS Nine hundred ninety-nine cases were analyzed; of these, 71 cases with TDIs were identified. The incidence of TDI was, therefore, determined to be 7.11%. A total of 60.56% involved the right hemidiaphragm, 19.72% the left hemidiaphragm, and 19.72% were present bilaterally. A total of 85.92% were present in men and 14.08% in women. Blunt force trauma comprised 33.80%, and penetrative trauma 61.97%. Most were associated with severe injuries. A total of 12.68% had organ herniation through the defects present. CONCLUSIONS Our study revealed that TDIs were more common than initially reported. The right side was more often involved in our study than in other studies. Diaphragmatic injuries were observed in 21.46% of all penetrative trauma cases received in a year.
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Affiliation(s)
- Charmaine van Wyk
- From the Department of Forensic Medicine, Sefako Makgatho Health Sciences University, Ga-Rankuwa
| | - Keven Khazamula Hlaise
- From the Department of Forensic Medicine, Sefako Makgatho Health Sciences University, Ga-Rankuwa
| | - Ryan Blumenthal
- Department of Forensic Medicine, University of Pretoria, Pretoria, South Africa
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Zhang Y, Peng J, Wu X, Zhu D, Chen Y. Gastrocutaneous fistula caused by mesh migration following diaphragmatic rupture repair. ANZ J Surg 2022; 93:1042-1043. [PMID: 36195990 DOI: 10.1111/ans.18082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 08/24/2022] [Accepted: 09/18/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Yuan Zhang
- Department of General Surgery, The Ninth Affiliated Hospital of Guangxi Medical University, Beihai, China
| | - Jun Peng
- Department of General Surgery, The Ninth Affiliated Hospital of Guangxi Medical University, Beihai, China
| | - Xingui Wu
- Department of General Surgery, The Ninth Affiliated Hospital of Guangxi Medical University, Beihai, China
| | - Dingjiao Zhu
- Department of Radiology, The Ninth Affiliated Hospital of Guangxi Medical University, Beihai, China
| | - Yaozhi Chen
- Department of General Surgery, The Ninth Affiliated Hospital of Guangxi Medical University, Beihai, China
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Imamović A, Wagner D, Lindenmann J, Fink-Neuböck N, Sauseng S, Bajric T, Werkgartner G, Mischinger HJ. Life threatening rupture of the diaphragm after Covid 19 pneumonia: a case report. J Cardiothorac Surg 2022; 17:145. [PMID: 35672705 PMCID: PMC9171738 DOI: 10.1186/s13019-022-01886-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 05/19/2022] [Indexed: 11/22/2022] Open
Abstract
Background The incidence of diaphragmatic rupture is low; however, it may be life threatening. Normally caused by blunt trauma, some cases are reported after pulmonary infections with extensive coughing. Covid 19 causes pulmonary infections and pneumonia and has been associated with weakening of the diaphragm after prolonged ventilation. We present a patient who suffered from diaphragmatic rupture 2 months after recovering from a severe Covid 19 pneumonia.
Case A 71 years old male patient presented with massive thoraco-abdominal pain and severe dyspnea. At the time of admission, the patient was diagnosed with rupture of the diaphragm and developed cardiogenic shock. Intraoperatively there was a 4 cm diameter large rupture of the diaphragm with enterothorax (transverse colon, stomach, spleen, parts of the jejunum). Avulsion of the mesenteric arteries made a segmental resection of the jejunum together with the spleen necessary. A jejuno-jejunostomy was performed and organs were replaced into the abdomen. The rupture of the diaphragm underwent primary closure with non-resorbable suture material. The patient has shown an uneventful post-operative course, fully recovered and was discharged on day 11 after surgery. Conclusion Covid 19 is a disease that is known to have various effects on different organs. The diaphragm is only paid heed in case of dysfunction. Also in the setting of Covid 19 it is not known as prominent effector organ. Nevertheless its affection by coughing caused by Covid 19 can lead to life threatening complications.
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Jones EK, Andrade R, Bhargava A, Diaz-gutierrez I, Rao M. Surgical management of delayed-presentation diaphragm hernia: A single-institution experience. JTCVS Tech 2022. [PMID: 35711179 PMCID: PMC9197083 DOI: 10.1016/j.xjtc.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/01/2022] [Accepted: 04/11/2022] [Indexed: 11/22/2022] Open
Abstract
Objectives Delayed-presentation diaphragm hernias are uncommon, and surgical management varies widely across practices. We describe our surgical experience with delayed-presentation diaphragm hernias as a case series of 14 patients, 9 of whom underwent minimally invasive repair. Methods We performed a retrospective chart review of our prospective database of all patients treated surgically for delayed-presentation diaphragm hernia at our institution from January 1, 2005, to April 30, 2021. We excluded patients with poststernotomy, post–left ventricular assist device, and previously diagnosed congenital hernias. We recorded patient demographics, etiology, laterality, chronicity, operative details, postoperative complications, and long-term results. Results We performed surgical repair of delayed-presentation diaphragm hernia in 14 patients. Eleven patients (79%) were male, the median age was 61 (18-83) years, the median body mass index was 29.2 (14.5-33.7), and 8 (57%) hernias were left-sided. Etiology was trauma (n = 7, 50%), iatrogenic (n = 5, 36%), and unknown (n = 2, 14%). Median time to presentation in patients with traumatic and iatrogenic hernias was 7.5 years (6 weeks to 38 years). Nine patients (64%) underwent minimally invasive repair, and 5 patients (36%) underwent open repair. We used a synthetic patch in all but 2 patients (86%). Median length of stay was 5 (3-27) days. Two patients (14%) had major complications. There were no deaths. Twelve patients (86%) had follow-up imaging at a median follow-up of 17 months (1-192) with zero recurrences. Conclusions Our experience suggests that a minimally invasive or an open approach to patients with a delayed-presentation diaphragm hernia is safe and effective. We recommend tailoring the surgical approach based on patient characteristics, anatomic considerations, and surgeons’ experience.
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Hettiarachchi M, Thalgahagoda S. Delayed presentation of traumatic right diaphragmatic hernia of a child. Journal of Pediatric Surgery Case Reports 2022. [DOI: 10.1016/j.epsc.2022.102222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Que Son T, Hieu Hoc T, Xuan Than L, Thu Huong T, Minh Hung D, Chien Quyet N, Thanh Tung T, Duc Long V. Laparotomy management of diaphragmatic and hollow viscera rupture combined with thoracic endovascular aortic repair after a traffic accident: A case report. Ann Med Surg (Lond) 2022. [PMID: 35198185 PMCID: PMC8844846 DOI: 10.1016/j.amsu.2022.103343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/25/2022] [Accepted: 02/01/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Road traffic incidents are the most common cause of multiple organ trauma in low- and middle-income countries. Multiple blunt intra-abdominal organs that rupture in conjunction with a ruptured aorta are terrible and rare. Case presentation A 65-year-old man sustained critical injuries during a traffic collision between a motorcycle and truck. The Injury Severity Score was 42 points,. After open abdominal exploration, we repaired the left diaphragmatic rupture with a 13-cm-long tear of IV grade (American Association for the Surgery of Trauma), resected partial small bowel, simple suture of the transverse colon, and Hartmann procedure in the descending colon. Thoracic endovascular aortic repair (TEVAR) was performed 22 h after laparotomy. Reconstruction of the head depicting a cheekbone fracture and inferior to the left orbital bone was performed on the 14th day. The patients survived and were discharged from the hospital, at 22 days without morbidity or mortality. Discussion Diaphragmatic rupture provides a signal to relate head, thoracic, and abdominal blunt trauma. If the patient sustains more serious life-threatening injuries that require emergency laparotomy or craniotomy, and aortic repair may be delayed. Laparotomy is the best initial surgical method in this case. TEVAR is a feasible and gold standard procedure for the treatment of patients with the necessary indications. Conclusion It is essential to evaluate the level of organ damage to properly coordinate the specialists. The timing of the operation and therapeutic alternatives should be decided for each patient. Traumatic diaphragmatic rupture (TDR) provides a signal to relate head, thoracic, and abdominal injuries. Multiple blunt intra-abdominal organs ruptured in conjunction with a ruptured aorta are terrible and rare traumas. Laparotomy is the best initial method and TEVAR is feasible for hemodynamically stable patients.
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İlhan M, Alizade E, Durak G, Kaan Gok A, Ertekin C. Can invasive diagnostic methods be reduced by magnetic resonance imaging in the diagnosis of diaphragmatic injuries in left thoracoabdominal penetrating injuries? J Minim Access Surg 2022; 18:431-437. [PMID: 35708387 PMCID: PMC9306128 DOI: 10.4103/jmas.jmas_259_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Špaková B, Gura M, Molnár M, Murgaš D, Dragula M. Traumatic diaphragmatic hernia in children. Journal of Pediatric Surgery Case Reports 2021. [DOI: 10.1016/j.epsc.2021.101984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Liu Q, Luan L, Zhang G, Li B. Treatment of Chronic Traumatic Diaphragmatic Hernia Based on Laparoscopic Repair: Experiences From 23 Cases. Front Surg 2021; 8:706824. [PMID: 34336921 PMCID: PMC8319600 DOI: 10.3389/fsurg.2021.706824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 06/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background: We aimed to investigate the safety and effectiveness of laparoscopic repair for treating chronic traumatic diaphragmatic hernia (CTDH). Methods: In this retrospective analysis, we included 23 cases with CTDH underwent laparoscopy in our hospital between June 2015 and October 2019 was performed. The patient characteristics were recorded. We compared the diameter of hernia ring, surgery duration, intraoperative bleeding volume, means of repairing, as well as the follow-up data. Results: All the patients underwent laparoscopic diaphragmatic hernia repair, without conversion to laparotomy or thoracotomy. The operation time ranged from 60 min to 200 min (mean, 108.04 ± 42.93 min). The blood loss volume ranged from 10 to 300 ml (mean volume, 63.48 ± 71.69 ml). The postoperative hospital stayed ranged from 5 to 15 days (mean, 6.22 ± 2.11 days). The patients were followed up for 1–50 months (mean, 17.5 ± 10.90 months). No recurrence of diaphragmatic hernia was found. Conclusions: Laparoscopic repair of CTDH is featured by fast recovery, high security, and effectiveness. Reducing the hernia contents and close of the hernia ring are crucial for the surgery that is performed based on the size and location of the diaphragmatic hernia.
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Affiliation(s)
- Qiaonan Liu
- Department of Hernia and Abdominal Wall Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Li Luan
- Department of Hernia and Abdominal Wall Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Guangyong Zhang
- Department of Gastrointestinal Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Bo Li
- Department of Hernia and Abdominal Wall Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
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Graan D, Amico F, Wills VL, Balogh ZJ. Subtle sign of diaphragm rupture involving the oesophageal hiatus. ANZ J Surg 2021; 92:546-548. [PMID: 34223692 DOI: 10.1111/ans.17053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/25/2021] [Accepted: 06/14/2021] [Indexed: 11/28/2022]
Affiliation(s)
- David Graan
- John Hunter Department of Traumatology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Francesco Amico
- John Hunter Department of Traumatology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Vanessa L Wills
- Department of General Surgery, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Zsolt J Balogh
- Department of Traumatology and Discipline of Surgery, John Hunter Hospital and University of Newcastle, Newcastle, New South Wales, Australia
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Solazzo A, Barone M, Bonanno D, Sofia C, Bottari A, Ascenti V, Familiari D, Mazziotti S, Cicero G, Monaco F. Simultaneous pneumothorax and pneumoperitoneum as a late consequence of traumatic injury of the diaphragm: Multimodality imaging approach with surgical correlation and treatment. Radiol Case Rep 2021; 16:2421-5. [PMID: 34257772 DOI: 10.1016/j.radcr.2021.05.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 05/31/2021] [Accepted: 05/31/2021] [Indexed: 11/22/2022] Open
Abstract
Simultaneous occurrence of pneumothorax and pneumoperitoneum is a rare event, usually related to traumas or surgical procedures involving the diaphragm. However, clinicians should be aware of the possible onset of these two clinical conditions even in patients without a recent clinical history that can clearly explain them. Cross-sectional imaging techniques are of great importance, providing crucial information about the patient's clinical status and guiding the following patient management. This work describes a unique case of a sudden occurrence of simultaneous pneumothorax and pneumoperitoneum in a previous asymptomatic man with a solely clinical history of minor trauma during childhood, evaluated through a multimodality imaging approach and treated with video-assisted thoracoscopy surgery.
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El Bakouri A, El Karouachi A, Bouali M, El Hattabi K, Bensardi FZ, Fadil A. Post-traumatic diaphragmatic rupture with pericardial denudation: A case report. Int J Surg Case Rep 2021; 83:105970. [PMID: 34029846 PMCID: PMC8163962 DOI: 10.1016/j.ijscr.2021.105970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/02/2021] [Accepted: 05/08/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Post-traumatic diaphragmatic rupture is a lesion of variable severity. It is a rare and difficult to diagnose pathology, it has been found in 0.4% of all traumatized patients and in 1.9% of blunt traumas. It can be associated with abdominal andthoracic lesions, particularly cardiac, which can be life-threatening. MATERIALS AND METHODS Our work is a retrospective case report with a descriptive aim concerning a patient operated for a post-traumatic diaphragmatic rupture within the department of general surgery of CHU Ibn Rochd Casablanca. This work has been reported in line with the SCARE 2020 criteria (17). CASE PRESENTATION A 60-year-old patient was admitted to the visceral surgical emergency department following a work accident (crushing between two carts) causing a thoraco-abdominal impact point trauma without initial loss of consciousness, nor externalized digestive hemorrhage or associated signs, but with a general condition alteration. The patient was conscious, dyspneic with a blood pressure of 100/50 mmHg and afebrile. Physical examination showed diffuse abdominal sensibility. The thoraco-abdomino-pelvic CT scan revealed the presence of a left thoracic hernia with gastric, colic and epiploic contents through a lateral defect of the left diaphragmatic dome. The decision was to directly send the patient to the operating room. Exploration found a large left diaphragmatic breach of 20 cm, a denudation of the pericardia, a medium-abundant hemoperitoneum and a hematoma of the right mesocolon. The procedure consisted of right hemicolectomy with ileocolic anastomosis, treatment of a diaphragmatic breach with a 2-silk raphia, thoracic drainage with a Joly drain, pericardial drainage with a Joly drain, pre-anastomotic drainage with 2 delbet slides, drainage of the Douglas and left subthreshold with 2 Salem catheters. The post-operative follow-up was simple. DISCUSSION Diaphragmatic rupture is a rare and difficult to diagnose condition. Traumatic diaphragmatic rupture (TDR) was found in 0.4% of all traumatized patients and in 1.9% of blunt trauma. Associated lesions of the spleen, liver and/or lungs were found in more than 30% of cases, with an overall mortality rate of 26.8% (1). Pericardial rupture following blunt chest trauma is rare and associated with a high mortality rate ranging from 30% to 64% (9). The physiopathology of this type of injury is not well understood, but the most accepted hypothesis describes an increase in intra-abdominal pressure due to a blunt creating a sufficiently high-pressure gradient between the chest and the abdomen to cause a diaphragmatic rupture. The common clinical symptoms of a diaphragmatic rupture are a marked respiratory distress and diffuse abdominal pain but it can be asymptomatic. Medical imaging exams visualize the ascended organs but it's more difficult to visualize the rupture itself. The chest X-ray is currently the first examination to be requested (4) and also helps in the diagnosis of injuries and diaphragm rupture (13). Surgical treatment includes the reduction of any visceral hernia, repair of the diaphragm and restoration of circulation, breathing and digestive functions. Laparotomy is generally used because of the complete exploration of the abdominal viscera, although it is easier to reduce herniated tissue and repair the diaphragm. CONCLUSION Diaphragmatic rupture with denudation of the heart is rare with poor prognosis and requires emergency surgery with close postoperative monitoring in the intensive care setting. SUMMARY Post-traumatic diaphragmatic rupture is a lesion of variable severity. It is a rare and difficult to diagnose pathology, it has been found in 0.4% of all traumatized patients and in 1.9% of blunt traumas. The lesions are more frequent in the left diaphragmatic dome compared to the right one, and exceptionally bilateral. Pericardial rupture following blunt chest trauma is rare and associated to a high mortality rate. It is often unrecognized and goes unnoticed in the acute phase. The most common clinical symptoms of diaphragmatic ruptures are respiratory distress and diffuse abdominal pain, as it can be asymptomatic. Its diagnosis is essentially radiological using CT scan, and requires emergency surgical treatment as soon as the diagnosis is suspected, in order to avoid the dreaded complications. Traumatic diaphragmatic rupture remains a diagnostic and therapeutic challenge. We report the case of a patient who presented a post-traumatic diaphragmatic rupture with pericardial damage operated in the visceral emergency department at the Ibn Rochd Hospital c in Casablanca, Morocco.
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Affiliation(s)
- A El Bakouri
- Visceral Surgery Emergency Department 35, University hospital center Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan 2 university, Casablanca, Morocco
| | - A El Karouachi
- Visceral Surgery Emergency Department 35, University hospital center Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan 2 university, Casablanca, Morocco.
| | - M Bouali
- Visceral Surgery Emergency Department 35, University hospital center Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan 2 university, Casablanca, Morocco
| | - K El Hattabi
- Visceral Surgery Emergency Department 35, University hospital center Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan 2 university, Casablanca, Morocco
| | - F Z Bensardi
- Visceral Surgery Emergency Department 35, University hospital center Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan 2 university, Casablanca, Morocco
| | - A Fadil
- Visceral Surgery Emergency Department 35, University hospital center Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan 2 university, Casablanca, Morocco
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Abstract
Traumatic diaphragmatic rupture (TDR) is an uncommon but life-threatening condition often
caused by blunt or penetrating trauma. Symptoms may appear late resulting in delayed or
missed diagnosis. We report here a case of a 28-year-old man who presented with left
subcostal pain and vomiting after recently binge drinking alcohol. He had experienced
bilateral rib fractures two years previously. Computed tomography (CT) showed massive left
pleural effusion and pleural fluid drained by thoracentesis had a bloody appearance. The
patient developed septic shock but emergency surgery showed no active bleeding.
Enhanced-CT showed herniated stomach with ischemic necrosis in the left thoracic cavity.
Total gastrectomy and diaphragmatic repair were successful and the patient had an
uneventful recovery. A high index of suspicion is necessary when evaluating haemothorax,
especially in patients with recent or previous thoraco-abdominal injury.
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Affiliation(s)
| | - Li-Yuan Ma
- Peking Union Medical College Hospital, Beijing, China.,Peking Union Medical College, Beijing, China
| | - Bing-Lu Li
- Peking Union Medical College Hospital, Beijing, China
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Agrawal S, Gajula B, Chongtham AK, Huda F, Basu S. Unusual Complication of Intercostal Tube Drainage of Penetrating Chest Injury: A Case Report. Cureus 2021; 13:e13813. [PMID: 33850673 PMCID: PMC8035531 DOI: 10.7759/cureus.13813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Penetrating chest injuries can lead to diaphragmatic injuries, which are often missed easily on initial assessments, especially in patients with polytrauma. We are usually more focused and biased towards other evident, immediately life-threatening injuries. The fact that clinical and radiological findings are subtle, especially on chest X-rays, which is sometimes the only investigation performed, highlights the importance of using higher imaging modalities in stable patients and that a clinician should be suspicious of this entity with the corresponding history. Intervening in such patients with the placement of intercostal drain can contribute to morbidity and mortality, as in our case, by causing inadvertent injury to the herniating structures. The case report briefs the same and emphasizes that thoracic injuries, especially penetrating ones, should ring a bell and should be carefully investigated further before the intervention.
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Affiliation(s)
- Saumya Agrawal
- Surgery, University of Illinois at Chicago, Chicago, USA
| | - Bhargav Gajula
- Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | | | - Farhanul Huda
- General Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Somprakas Basu
- General Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
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Beshay M, Krüger M, Singh K, Borgstedt R, Benhidjeb T, Bölke E, Vordemvenne T, Schulte Am Esch J. Grave thoraco-intestinal complication secondary to an undetected traumatic rupture of the diaphragm: a case report. Eur J Med Res 2021; 26:19. [PMID: 33557953 PMCID: PMC7871382 DOI: 10.1186/s40001-021-00488-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/23/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Diaphragmatic lesions as a result of blunt or penetrating trauma are challenging to detect in the initial trauma setting. This is especially true when diaphragmatic trauma is part of a polytrauma. Complications of undetected diaphragmatic defects with incarcerating bowel are rare, but as in our patient can be serious. CASE PRESENTATION A 57-year-old female presented to the Emergency Room of our Hospital in a critical condition with 3 days of increasing abdominal pain. The initial clinical examination showed peritonism with tinkling peristaltic bowel sounds of mechanical obstruction. A thoraco-abdominal CT scan demonstrated colon prolapsed through the left diaphragmatic center with a large sero-pneumothorax under tension. As the patient was hemodynamically increasingly unstable with developing septic shock, an emergency laparotomy was performed. After retraction of the left colon, which had herniated through a defect of the tendinous center of the left diaphragm and was perforated due to transmural ischemia, large amounts of feces and gas discharged from the left thorax. A left hemicolectomy resulting in a Hartmann-type procedure was performed. A fully established pleural empyema required meticulous debridement and lavage conducted via the 7-10 cm in diameter phrenic opening followed by a diaphragmatic defect reconstruction. Due to pneumonia and recurring pleural empyema redo-debridement of the left pleural space via thoracotomy were required. The patient was discharged on day 56. A thorough history of possible trauma revealed a bicycle-fall trauma 7 months prior to this hospitalization with a surgically stabilized fracture of the left femur and conservatively treated fractures of ribs 3-9 on the left side. CONCLUSION This is the first report on a primarily established empyema at the time of first surgical intervention for feco-pneumothorax secondary to delayed diagnosed diaphragmatic rupture following abdomino-thoracic blunt trauma with colic perforation into the pleural space, requiring repetitive surgical debridement in order to control local and systemic sepsis. Thorough investigation should always be undertaken in cases of blunt abdominal and thoracic trauma to exclude diaphragmatic injury in order to avoid post-traumatic complications.
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Affiliation(s)
- Morris Beshay
- Department of Thoracic Surgery, University Hospital OWL of the University Bielefeld, campus Bielefeld-Bethel, Bielefeld, Germany
| | - Martin Krüger
- Department of Internal Medicine and Gastroenterology, University Hospital OWL of the University Bielefeld, campus Bielefeld-Bethel, Bielefeld, Germany
| | - Kashika Singh
- Department of General and Visceral Surgery, University Hospital OWL of the University Bielefeld, campus Bielefeld-Bethel, Bielefeld, Germany
| | - Rainer Borgstedt
- Department of Anesthesiology, Intensive Care, Emergency-, Transfusion- and Pain-Medicine, University Hospital OWL of the University Bielefeld, campus Bielefeld-Bethel, Bielefeld, Germany
| | - Tahar Benhidjeb
- Department of General and Visceral Surgery, University Hospital OWL of the University Bielefeld, campus Bielefeld-Bethel, Bielefeld, Germany
| | - Edwin Bölke
- Medical Faculty, Department of Radiation Oncology, Heinrich Heine University, Duesseldorf, Germany
| | - Thomas Vordemvenne
- Department of Trauma Surgery and Orthopedics, University Hospital OWL of the University Bielefeld, campus Bielefeld-Bethel, Bielefeld, Germany
| | - Jan Schulte Am Esch
- Department of General and Visceral Surgery, University Hospital OWL of the University Bielefeld, campus Bielefeld-Bethel, Bielefeld, Germany.
- Department of General and Visceral Surgery, Evangelisches Klinikum Bethel, Schildescher Str. 99, 33611, Bielefeld, Germany.
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Pham J, Kemp J, Pruitt J. Acute Abdomen in Adult Trauma. Semin Roentgenol 2020; 55:385-399. [PMID: 33220785 DOI: 10.1053/j.ro.2020.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- John Pham
- Department of Radiology, Division of Abdominal Imaging, UT Southwestern Medical Center, Dallas, TX
| | - Justine Kemp
- Department of Radiology, Division of Abdominal Imaging, UT Southwestern Medical Center, Dallas, TX
| | - Jeffrey Pruitt
- Department of Radiology, Division of Abdominal Imaging, UT Southwestern Medical Center, Dallas, TX.
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Variawa S, Marais R, Buitendag J, Edge J, Steyn E. Symptomatic hepatothorax presenting 25 years after penetrating thoracoabdominal injury. Ann R Coll Surg Engl 2020; 103:e17-e19. [PMID: 32969264 DOI: 10.1308/rcsann.2020.0195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Hepatic herniation through the diaphragm is a rare finding. It generally occurs due to a congenital diaphragmatic abnormality or blunt trauma resulting in a diaphragmatic defect. Making the diagnosis is difficult, as there are few definitive clinical signs and chest radiograph (CXR) findings may be non-specific. To our knowledge, only a single case report exists of penetrating right diaphragm injury leading to hepatic herniation. A 42-year-old man presented to the emergency department of a regional hospital with hyperglycaemia and exertional dyspnoea. He was diagnosed with diabetes mellitus type 2. He gave a history of smoking for 15 pack-years, was negative for retroviral disease and had no history of pulmonary tuberculosis. He had no significant surgical history but reported being stabbed with a knife in 1995. The point of entry was below the level of the nipple in the right anterior axillary line. At the time, he was treated with an intercostal drain and discharged home. CXR showed a right-sided chest mass. We considered a differential diagnosis of pulmonary consolidation, diaphragm eventration or hepatothorax. Computerized tomography of the chest and abdomen demonstrated apparent intrathoracic extension of the right liver lobe and partial attenuation of the superior vena cava and right atrium due to a mass effect. The upper border of the liver abutted the aortic arch. Surgical treatment options were discussed. The patient declined surgery and will be followed up as an outpatient.
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Affiliation(s)
- S Variawa
- Stellenbosch University, South Africa
| | - R Marais
- Stellenbosch University, South Africa
| | | | - J Edge
- Stellenbosch University, South Africa
| | - E Steyn
- Stellenbosch University, South Africa
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Elkbuli A, Meneses E, Shepherd A, McKenney M, Boneva D. Traumatic diaphragmatic rupture successfully managed in 4-year-old patient: Case report and literature review. Int J Surg Case Rep 2020; 72:237-240. [PMID: 32553935 PMCID: PMC7300228 DOI: 10.1016/j.ijscr.2020.06.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 06/06/2020] [Indexed: 12/01/2022] Open
Abstract
Presentation of a left sided traumatic diaphragmatic rupture following a blunt trauma in a pediatric patient. Rapid assessment and identification of a traumatic diaphragmatic hernia with prompt repair. Uncomplicated postoperative course and hospital discharge following traumatic diaphragmatic hernia excellent outcomes.
Introduction Traumatic diaphragmatic ruptures are rare injuries in the pediatric population that can present with dyspnea, abdominal pain, or even be asymptomatic. Case presentation A 4-year-old boy presents to our Level 1 Pediatric Trauma Center after being hit by a car. He presented awake and alert but with low oxygen saturations and chief complaint of left sided abdominal and chest pain. The initial chest radiograph showed an elevated left diaphragm and bilateral opacities. A laparoscopic approach confirmed the diagnosis of a diaphragm rupture and an open approach allowed for the diaphragm repair, after returning the stomach, colon and spleen back to the abdominal cavity. He had an uneventful recovery and was discharged home on postoperative day seven. Discussion Traumatic diaphragmatic hernia continues to be a difficult diagnosis to make without a high index of suspicion with variable time to diagnosis. This has been attributed to nonspecific clinical presentation and low incidence of the condition. Chest radiograph has been suggested to be an appropriate initial imaging modality with computed tomography as an accurate adjunct. Right sided diaphragm hernias, although less common, still occur and are often misdiagnosed. Recovery without significant morbidity after definitive surgical treatment with laparotomy is common. Conclusion Consider a traumatic diaphragmatic hernia in a blunt pediatric trauma patient with abdominal pain and dyspnea once other life-threatening injuries have been ruled out. This is an easily missed injury that can lead to significant morbidity and mortality if not identified early in the patient’s hospital course.
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Affiliation(s)
- Adel Elkbuli
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA.
| | - Evander Meneses
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA
| | - Aaron Shepherd
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA
| | - Mark McKenney
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA; University of South Florida, Tampa, FL, USA
| | - Dessy Boneva
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA; University of South Florida, Tampa, FL, USA
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Wei F, Li Y. Successful management requiring multidisciplinary cooperation between seven departments for a large right-sided incarcerated traumatic diaphragmatic hernia: a case report and review of literature. AME Case Rep 2020; 4:10. [PMID: 32420533 DOI: 10.21037/acr.2020.03.02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 02/28/2020] [Indexed: 11/06/2022]
Abstract
We present a rare case of incarcerated traumatic diaphragmatic hernia (TDH) at the right-side presenting as dramatic dyspnea and acute gastrointestinal obstruction, which required urgent operative repair. This entity is sometimes difficult to ascertain after acute trauma and then consequently give rise to diagnostic delays with life-threatening outcomes. Successful management required a coordinated effort between anesthetist, sonographer, intensive care specialist, thoracic, urological, hepatobiliary and gastrointestinal surgeons. Tight and active multidisciplinary cooperation in this case manifested the positive energy in emergent resuscitation.
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Affiliation(s)
- Fuwang Wei
- Department of Thoracic Surgery, Cancer Center of Guangzhou Medical University, Guangzhou 510095, China
| | - Yanchang Li
- Department of Dermatovenerology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, China
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Shaban Y, Elkbuli A, McKenney M, Boneva D. Traumatic Diaphragmatic Rupture with Transthoracic Organ Herniation: A Case Report and Review of Literature. Am J Case Rep 2020; 21:e919442. [PMID: 31896740 PMCID: PMC6977640 DOI: 10.12659/ajcr.919442] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Female, 59-year-old Final Diagnosis: Axillo-subclavian vessel injuries Symptoms: Shortness of breath Medication: — Clinical Procedure: — Specialty: Surgery
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Affiliation(s)
- Youssef Shaban
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA
| | - Adel Elkbuli
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA
| | - Mark McKenney
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA.,University of South Florida, Tampa, FL, USA
| | - Dessy Boneva
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA.,University of South Florida, Tampa, FL, USA
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