Traumatic pericardiophrenic hernia: a report of 3 cases

Outside the box: extra-pericardial tamponade due to acute recurrence of hiatus hernia

Cardiac tamponade is defined as a life-threatening, slow or rapid compression of the heart due to the pericardial accumulation of fluid, pus, thrombus or gas as a result of effusion, trauma, or myocardial rupture. We describe the case of a lady who developed classic signs of cardiac tamponade immediately after an open hiatus hernia repair. Computed tomographic imaging revealed extrapericardial hernia recurrence causing cardiac compression. We believe this is the first such reported case. We conclude that cardiac tamponade from acute recurrence of hiatus hernia must be considered in the unstable postoperative patient and that the definition of cardiac tamponade is expanded to include extrapericardial pathologies.

The Cardiac Pendulum: Blunt Rupture of the Pericardium with Strangulation of the Heart

BACKGROUND

Blunt injury of the pericardium with strangulation of the heart is a rare clinical injury.

METHODS

We conducted a review of clinical records and performed prospective collection of forensic data from a large urban medical examiner's office.

RESULTS

Ten cases of blunt injury to the pericardium were identified. All were secondary to blunt trauma. Nine of the 10 cases had associated chest wall injuries and 5 of the 10 cases had cardiac strangulation.

CONCLUSION

Pericardial lacerations are common findings at autopsy. Clinically, those that survive to the hospital have a confusing presentation. They are often diagnosed during emergent thoracotomy for hemodynamic instability. Hemodynamic deterioration associated with change in patient position may be a clue to cardiac strangulation.

Bowel herniation through the torn diaphragm: II. Intestinal herniation

Five cases of intestinal herniation through the torn diaphragm are presented. Plain radiography, single-contrast examination, and ultrasonography show some simple features that either have not been previously published or need restatement. Some pitfalls that still delay diagnosis are also shown.

Delayed presentation of pericardial rupture with luxation of the heart following blunt trauma: a case report

OBJECTIVE

To present an unusual case of delayed presentation of pericardial rupture with luxation of the heart 6 months after the initial injury.

DESIGN

Diagnosis, outcome, associated injuries, and treatment are discussed.

METHODS

A high index of suspicion is required to make the diagnosis; no single diagnostic test can be used as a screening tool.

CONCLUSION

Once recognized, treatment of pericardial rupture is relatively simple.

Traumatic intrapericardial diaphragmatic hernia

Traumatic intrapericardinal diaphragmatic hernia is a rare occurrence following blunt thoracoabdominal injuries. We have reviewed 59 cases reported in the literature and added three. Emphasis is placed on the diagnostic difficulties encountered, with some discussion regarding the management and surgical approach.

Delayed presentation of intrapericardial diaphragmatic hernia, an unusual cause of colon obstruction

The earliest symptoms of diaphragmatic hernia may not appear until viscera incarcerate in it years after the causal injury. The most unusual site for a diaphragmatic hernia to occur is through the central tendon of the diaphragm into the pericardium. We present the case of a 43-year-old man who suffered a bowel obstruction when the transverse colon and omentum became incarcerated in the intrapericardial diaphragmatic hernia. The defect presumably resulted from blunt chest and abdominal trauma received 15 years earlier. The delayed presentation of intrapericardial diaphragmatic hernia is reviewed, and recommendations for evaluation and treatment are made.

Pericardiophrenic hernia secondary to a surgically created peritoneal and pericardial window

Intrapericardial herniation is rare; 40 cases have been reported. To our knowledge, this is the first report of a case resulting from a recently developed surgical procedure: the pericardial and peritoneal window technique. Diagnostic modalities included plain films, barium studies, and a computed tomography scan.