1
|
Maldonado-Chaar SM, Miró-González ÁA, Ramírez N, Ramirez-Ferrer LO. Delayed hepatothorax: An unusual presentation case report. Int J Surg Case Rep 2022; 94:107017. [PMID: 35421730 PMCID: PMC9019230 DOI: 10.1016/j.ijscr.2022.107017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/19/2022] [Accepted: 03/31/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction and importance We are reporting a case of a delayed hepatothorax due to a right-sided diaphragmatic rupture 13 years after a blunt trauma due to a motor vehicle accident, who presented as isolated gastritis without any type of respiratory symptomatology. Case presentation Patient refers that his symptoms remained refractory to medical treatment and had gotten worse over time. Chest wall inspection showed asymmetric thoracic expansion and a decreased movement of right hemithorax when compared to the left. Cardiorespiratory auscultation was significant for growling sounds on the right second intercostal space and reduction of breath sounds on the right lower lobe region of the lung when compared to the left side. Clinical discussion Thoracotomy was indicated since patient presented late. Meanwhile, laparotomy would have been appropriate if the patient had presented immediately after trauma. After the procedure, the patient presented in great condition and all the gastrointestinal symptoms associated with the traumatic diaphragmatic hernia had resolved. We propose that the absence of respiratory symptoms in our patient could be due to the progressive adaptation of small, cumulative changes in decreasing breathing capacity through time. Conclusion A case like ours has not been reported in the literature and clinicians should take this case report into consideration when suspecting a possible diagnosis of a delayed traumatic diaphragmatic hernia that may be complicated by a hepatothorax. We recommend maintaining a high index of clinical suspicion for hepatothorax due to delayed traumatic diaphragmatic hernia for all patients with a history of trauma. Hepatothorax is a rare and severe complication of right diaphragmatic ruptures. A unique case where a patient presented with only gastrointestinal symptoms Thoracotomy approach used due to delayed presentation High index of suspicion should be maintained for patients with trauma history.
Collapse
|
2
|
Perrone G, Giuffrida M, Annicchiarico A, Bonati E, Del Rio P, Testini M, Catena F. Complicated Diaphragmatic Hernia in Emergency Surgery: Systematic Review of the Literature. World J Surg 2020; 44:4012-4031. [DOI: 10.1007/s00268-020-05733-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2020] [Indexed: 12/18/2022]
|
3
|
Mousa W, Lapa C, Grossart C, Haq A. Delayed presentation of traumatic diaphragmatic rupture with tension colothorax and strangulation of the transverse colon. BMJ Case Rep 2020; 13:13/5/e233336. [PMID: 32376658 DOI: 10.1136/bcr-2019-233336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 26-year-old man presented to emergency department with respiratory distress. The initial diagnosis after chest X-ray was massive haemothorax, after insertion of a chest drain and further investigations, it turned up to be a rare case of a delay presentation of traumatic diaphragmatic rupture (DR) (after 1 year of the initial trauma). After excessive resuscitation of the patient in the emergency department, the patient underwent an emergency laparotomy which revealed ischaemic transverse colon herniated into the chest through a 7 cm diaphragmatic defect. Resection of the ischaemic bowel had been done, and the patient admitted to Intensive Therapy Unit (ITU) postoperatively. The patient had an uneventful recovery and discharged home on postoperative day 9. As DR after thoracoabdominal trauma is a rare condition that can be missed at initial presentation, we would like to highlight the main challenges in diagnosing and managing similar cases after reviewing related cases in the literature.
Collapse
Affiliation(s)
- Wassim Mousa
- General Surgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Christo Lapa
- Colorectal Surgery Departement, King's College Hospital NHS Trust, London, UK
| | - Cathleen Grossart
- Emergency Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Asif Haq
- Colorectal Surgery Departement, King's College Hospital NHS Trust, London, UK
| |
Collapse
|
4
|
Oka S, Ono K, Kajiyama K, Yoshimatsu K. Two extremely rare cases of extrapleural hematoma. Surg Case Rep 2019; 5:200. [PMID: 31844997 PMCID: PMC6915188 DOI: 10.1186/s40792-019-0760-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Extrapleural hematoma is uncommon. However, according to the size of hematoma and/or the progression of anemia, surgical treatment to control bleeding might be necessary because a huge hematoma can cause ventilator and circulatory disturbances to press heart and lung. We present two unusual cases of huge extrapleural hematoma in an anticoagulated patient with no apparent history of trauma or otherwise traumatic episodes. CASE PRESENTATION Case 1: A 78-year-old man presented to our emergency department with pain in his right shoulder and disturbance of consciousness. He had no apparent history of trauma. Computed tomography (CT) of the chest revealed the presence of a huge lens-like encapsulated lesion measuring 220 × 90 mm in the right thoracic cavity. These findings all supported a diagnosis of extrapleural hematoma with hemothorax. Case 2: A 73-year-old man was brought to our hospital by ambulance after bruising his back in his house. CT of the chest revealed the presence of a huge lens-like encapsulated lesion measuring 230 × 70 mm in the left thoracic cavity. Hemorrhagic effusion was obtained by thoracocentesis, and the lesion was suspected of being a hematoma. In both two cases, we performed video-assisted thoracic surgery (VATS), which was minimally invasive and effective. These two patients were cured and discharged smoothly after surgery. CONCLUSIONS We reported two rare cases of extrapleural hematoma. This disease requires close attention when it manifests in patients undergoing anticoagulation therapy. Regarding treatment, VATS was particularly effective in these cases.
Collapse
Affiliation(s)
- Soichi Oka
- Thoracic Surgery, Kokura Memorial Hospital, Asano, Kokurakita-ku, Kitakyushu-shi, Fukuoka, 802-8555, Japan.
| | - Kenji Ono
- Thoracic Surgery, Kokura Memorial Hospital, Asano, Kokurakita-ku, Kitakyushu-shi, Fukuoka, 802-8555, Japan
| | - Kenta Kajiyama
- Thoracic Surgery, Kokura Memorial Hospital, Asano, Kokurakita-ku, Kitakyushu-shi, Fukuoka, 802-8555, Japan
| | - Katsuma Yoshimatsu
- Thoracic Surgery, Kokura Memorial Hospital, Asano, Kokurakita-ku, Kitakyushu-shi, Fukuoka, 802-8555, Japan
| |
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
|
Testini M, Girardi A, Isernia RM, De Palma A, Catalano G, Pezzolla A, Gurrado A. Emergency surgery due to diaphragmatic hernia: case series and review. World J Emerg Surg 2017; 12:23. [PMID: 28529538 PMCID: PMC5437542 DOI: 10.1186/s13017-017-0134-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/09/2017] [Indexed: 01/13/2023] Open
Abstract
Background Congenital diaphragmatic hernia (CDH) is a congenital abnormality, rare in adults with a frequency of 0.17–6%. Diaphragmatic rupture is an infrequent consequence of trauma, occurring in about 5% of severe closed thoraco-abdominal injuries. Clinical presentation ranges from asymptomatic cases to serious respiratory or gastrointestinal symptoms. Diagnosis depends on anamnesis, clinical signs and radiological investigations. Methods From May 2013 to June 2016, six cases (four females, two males; mean age 58 years) of diaphragmatic hernia were admitted to our Academic Department of General Surgery with respiratory and abdominal symptoms. Chest X-ray, barium studies and CT scan were performed. Results Case 1 presented left diaphragmatic hernia containing transverse and descending colon. Case 2 showed left CDH which allowed passage of stomach, spleen and colon. Case 3 and 6 showed stomach in left hemithorax. Case 4 presented left diaphragmatic hernia which allowed passage of the spleen, left lobe of liver and transverse colon. Case 5 had stomach and spleen herniated into the chest. Emergency surgery was always performed. The hernia contents were reduced and defect was closed with primary repair or mesh. In all cases, post-operative courses were uneventful. Conclusion Overlapping abdominal and respiratory symptoms lead to diagnosis of diaphragmatic hernia, in patients with or without an history of trauma. Chest X-ray, CT scan and barium studies should be done to evaluate diaphragmatic defect, size, location and contents. Emergency surgical approach is mandatory reducing morbidity and mortality.
Collapse
Affiliation(s)
- Mario Testini
- Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University Medical School "Aldo Moro" of Bari, Bari, Italy
| | - Antonia Girardi
- Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University Medical School "Aldo Moro" of Bari, Bari, Italy
| | - Roberta Maria Isernia
- Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University Medical School "Aldo Moro" of Bari, Bari, Italy
| | - Angela De Palma
- Department of Thoracic Surgery, University of Bari, Bari, Italy
| | - Giovanni Catalano
- Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University Medical School "Aldo Moro" of Bari, Bari, Italy
| | - Angela Pezzolla
- Unit of Laparoscopic Surgery, Department of Emergency and Organ Transplantation, University Medical School "A. Moro" of Bari, Bari, Italy
| | - Angela Gurrado
- Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University Medical School "Aldo Moro" of Bari, Bari, 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
|
Thiam O, Konate I, Gueye ML, Toure AO, Seck M, Cisse M, Diop B, Dirie ES, Ka O, Thiam M, Dieng M, Dia A, Toure CT. Traumatic diaphragmatic injuries: epidemiological, diagnostic and therapeutic aspects. SPRINGERPLUS 2016; 5:1614. [PMID: 27652187 PMCID: PMC5028363 DOI: 10.1186/s40064-016-3291-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 09/11/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Diaphragmatic injuries include wounds and diaphragm ruptures, due to a thoracoabdominal blunt or penetrating traumas. Their incidence ranges between 0.8 and 15 %. The diagnosis is often delayed, despite several medical imaging techniques. The surgical management remains controversal, particularly for the choice of the surgical approach and technique. The mortality is mainly related to associated injuries. The aim of our study was to evaluate the incidence of diaphragmatic injuries occuring in thoraco-abdominal traumas, and to discuss their epidemiology, diagnosis and treatment. PATIENTS AND METHODS We performed a retrospective study over a period of 21 years, between January 1994 and June 2015 at the Department of General Surgery of the Aristide Le Dantec hospital in Dakar, Senegal. All patients diagnosed with diaphragmatic injuries were included in the study. RESULTS Over the study period, 1535 patients had a thoraco-abdominal trauma. There were 859 cases of blunt trauma, and 676 penetrating chest or abdominal trauma. Our study involved 20 cases of diaphragmatic injuries (1.3 %). The sex-ratio was 4. The mean age was 33 years. Brawls represented 83.3 % (17 cases). Stab attacks represented 60 % (12 cases). The incidence of diaphragmatic injury was 2.6 %. The wound was in the thorax in 60 % (seven cases). Chest radiography was contributory in 45 % (nine cases). The diagnosis of wounds or ruptures of the diaphragm was done preoperatively in 45 % (nine cases). The diaphragmatic wound was on the left side in 90 % (18 cases) and its mean size was 4.3 cm. The surgical procedure involved a reduction of herniated viscera and a suture of the diaphragm by "X" non absorbable points in 85 % (17 cases). A thoracic aspiration was performed in all patients. Morbidity rate was 10 % and mortality rate 5 %. CONCLUSION The diagnosis of diaphragmatic rupture and wounds remains difficult and often delayed. They should be kept in mind in any blunt or penetrating thoraco-abdominal trauma. Diaphragmatic lesions are usually located on the left side. Surgery is an efficient treatment.
Collapse
Affiliation(s)
- Ousmane Thiam
- General Surgery Department, Aristide Le Dantec Teaching Hospital, Dakar, Senegal
| | - Ibrahima Konate
- Surgery and Surgical Specialties Department, Gaston Berger University, Saint-Louis, Senegal
| | | | - Alpha Omar Toure
- General Surgery Department, Aristide Le Dantec Teaching Hospital, Dakar, Senegal
| | - Mamadou Seck
- General Surgery Department, Aristide Le Dantec Teaching Hospital, Dakar, Senegal
| | - Mamadou Cisse
- General Surgery Department, Aristide Le Dantec Teaching Hospital, Dakar, Senegal
| | - Balla Diop
- General Surgery Department, Aristide Le Dantec Teaching Hospital, Dakar, Senegal
| | - Elias Said Dirie
- General Surgery Department, Aristide Le Dantec Teaching Hospital, Dakar, Senegal
| | - Ousmane Ka
- General Surgery Department, Aristide Le Dantec Teaching Hospital, Dakar, Senegal
| | - Mbaye Thiam
- General Surgery Department, Aristide Le Dantec Teaching Hospital, Dakar, Senegal
| | - Madieng Dieng
- General Surgery Department, Aristide Le Dantec Teaching Hospital, Dakar, Senegal
| | - Abdarahmane Dia
- General Surgery Department, Aristide Le Dantec Teaching Hospital, Dakar, Senegal
| | - Cheikh Tidiane Toure
- General Surgery Department, Aristide Le Dantec Teaching Hospital, Dakar, Senegal
| |
Collapse
|
9
|
Quadrozzi F, Favoriti P, Favoriti M, Cofini G. Unusual repair in a rare case of hepatothorax due to right-sided diaphragmatic rupture: case report. G Chir 2016; 37:84-5. [PMID: 27381695 DOI: 10.11138/gchir/2016.37.2.084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Intra-thoracic herniation of abdominal organs following diaphragmatic rupture represents an unusual clinical occurrence with great diagnostic difficulty. The authors present a case of right diaphragmatic rupture related to peritonitis due to perforated duodenal ulcer in previous (1 year before) thoraco-abdominal trauma with complete intra-thoracic herniation of the liver, gallbladder, ascending and transverse colon and lung collapse. The preoperative diagnosis has been based on clinical, chest X-ray, and ultrasound examination. The patient, because of very serious respiratory and hemodynamic distress, immediately underwent surgery (thoraco-laparotomic approach) with reduction of the liver, gallbladder, ascending and transverse colon in the abdominal cavity, perforated duodenal ulcer suture and repair of diaphragmatic tear using an unusual repair mode: suture of autologous fascia lata graft to the diaphragm. Postoperative chest radiography showed the normal location of right diaphragmatic border.
Collapse
MESH Headings
- Adult
- Colon, Ascending/surgery
- Colon, Transverse/surgery
- Duodenal Ulcer/complications
- Gallbladder/surgery
- Hernia, Diaphragmatic/diagnostic imaging
- Hernia, Diaphragmatic/etiology
- Hernia, Diaphragmatic/microbiology
- Hernia, Diaphragmatic/surgery
- Herniorrhaphy
- Humans
- Liver/surgery
- Male
- Peritonitis/complications
- Peritonitis/microbiology
- Pulmonary Atelectasis/diagnostic imaging
- Pulmonary Atelectasis/etiology
- Pulmonary Atelectasis/surgery
- Rupture, Spontaneous/etiology
- Treatment Outcome
- Wounds, Nonpenetrating/diagnosis
- Wounds, Nonpenetrating/etiology
- Wounds, Nonpenetrating/surgery
Collapse
|
10
|
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
|
11
|
Baek SJ, Kim J, Lee SH. Hepatothorax due to a right diaphragmatic rupture related to duodenal ulcer perforation. World J Gastroenterol 2012; 18:5649-52. [PMID: 23112562 PMCID: PMC3482656 DOI: 10.3748/wjg.v18.i39.5649] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 06/01/2012] [Accepted: 06/15/2012] [Indexed: 02/06/2023] Open
Abstract
Here, we present the case of a 53-year-old man with a hepatothorax due to a right diaphragmatic rupture related to duodenal ulcer perforation. On admission, the patient complained of severe acute abdominal pain, with physical examination findings suspicious for a perforated peptic ulcer. Of note, the patient had no history of other medical conditions or recent trauma, and the initial chest radiography and laboratory findings were not specific. A subsequent abdominal computed tomography revealed intrathoracic displacement of the liver, gallbladder, transverse colon and omentum through a right diaphragmatic defect. The patient then underwent an explorative laparotomy that confirmed duodenal ulcer perforation. A primary repair of the duodenal perforation was performed, and the diaphragmatic defect was repaired using a polytetrafluoroethylene patch after the organs were reduced and the cavity irrigated. This particular case proves interesting as right-sided spontaneous diaphragmatic ruptures are very rare and difficult to diagnose. Additionally, the best treatment for such large diaphragmatic defects is still controversial, especially in cases of intrathoracic or intra-abdominal contamination.
Collapse
|
12
|
Kaifi JT, Kavuturu S, Judelson D, Staveley-O'Carroll KF. Budd-Chiari syndrome and post-traumatic diaphragmatic hernia. J Thorac Cardiovasc Surg 2012; 143:e21-2. [PMID: 22341415 DOI: 10.1016/j.jtcvs.2012.01.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 12/31/2011] [Accepted: 01/16/2012] [Indexed: 11/17/2022]
MESH Headings
- Accidental Falls
- Budd-Chiari Syndrome/diagnostic imaging
- Budd-Chiari Syndrome/etiology
- Budd-Chiari Syndrome/surgery
- Female
- Hepatectomy
- Hernia, Diaphragmatic, Traumatic/diagnostic imaging
- Hernia, Diaphragmatic, Traumatic/etiology
- Hernia, Diaphragmatic, Traumatic/surgery
- Humans
- Suture Techniques
- Thoracic Surgical Procedures
- Tomography, X-Ray Computed
- Treatment Outcome
- Wounds, Nonpenetrating/diagnostic imaging
- Wounds, Nonpenetrating/etiology
- Wounds, Nonpenetrating/surgery
- Young Adult
Collapse
Affiliation(s)
- Jussuf T Kaifi
- Department of Surgery, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA.
| | | | | | | |
Collapse
|
13
|
Guner A, Ozkan OF, Bekar Y, Kece C, Kaya U, Reis E. Management of Delayed Presentation of a Right-Side Traumatic Diaphragmatic Rupture. World J Surg 2011; 36:260-5. [DOI: 10.1007/s00268-011-1362-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
14
|
Guner A, Bekar Y, Kece C, Kahraman I, Sezer C, Reis E. Delayed enterothorax and hepatothorax due to missed right-sided traumatic diaphragmatic rupture. Am J Emerg Med 2011; 30:263.e7-10. [PMID: 21208759 DOI: 10.1016/j.ajem.2010.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 11/12/2010] [Indexed: 11/25/2022] Open
Abstract
Traumatic diaphragma ruptures (DRs) are an unusual condition after blunt thoracoabdominal trauma, and there are some difficulties in the diagnosis, in the absence of the additional life-threatening injuries. Right-sided injuries are less frequent than left-sided injuries and may be missed easily. Intrathoracic herniation of abdominal organs is an uncommon condition for right-sided DR. Particularly, to our knowledge, progressive hepatothorax and enterothorax that develop over years are a very rare presentation of DR. Herein, we present a case of progressive thoracic herniation of the abdominal organs, diagnosed 22 years after the initial trauma.
Collapse
Affiliation(s)
- Ali Guner
- Department of General Surgery, Trabzon Numune Training and Research Hospital, Trabzon, Turkey.
| | | | | | | | | | | |
Collapse
|
15
|
Abstract
Chronic traumatic diaphragmatic hernia is an uncommon but persistent diagnosis associated with significant morbidity and mortality. Chronic TDH describes a spectrum of disease in antecedent mechanism of injury, timing of presentation, size of diaphragmatic defect, and amount and type of tissue displaced into the chest. Multiplanar CT with coronal, sagittal, and axial reconstruction is most effective in making this diagnosis. Once diagnosed, repair should be undertaken. Although transabdominal approaches may be successful, the authors prefer an open transthoracic approach, recognizing that either approach may need to incorporate access into the other body cavity to complete the repair. Basic hernia principles apply including the construction of a tension-free repair, which may necessitate the use of prosthetics. As surgeons become increasingly comfortable with minimally invasive techniques, more chronic TDH are likely to be approached in this fashion. Finally, as much of the morbidity and mortality is associated with the catastrophic consequences of chronic TDH, vigilance needs to be applied in an attempt to diagnose and then repair TDH while in the latent stage prior to the development of the catastrophic complications that herald the obstructive stage.
Collapse
|
16
|
Somford MP, Nuytinck HKS, Vos DI. A case of delayed diagnosis of a right-sided diaphragm rupture with a review of the literature. Eur J Trauma Emerg Surg 2009; 35:499-502. [PMID: 26815218 DOI: 10.1007/s00068-008-8124-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2008] [Accepted: 10/15/2008] [Indexed: 10/21/2022]
Abstract
Right-sided diaphragm rupture is one of the typical injuries found during a secondary or tertiary survey after a major blunt trauma. This is mainly due to the apparently normal aspect of primary X-rays of the thorax. A right-sided diaphragm rupture can cause severe atelectasis of the right lower lobe of the lung, due to a hepatothorax. We present a case of a delayed diagnosis of right-sided diaphragm rupture, which was discovered by accident because of a new trauma. We review the literature on right-sided diaphragm rupture and its treatment.
Collapse
Affiliation(s)
| | | | - Dagmar I Vos
- Amphia Hospital, Surgery, Breda, The Netherlands. .,Amphia Hospital, Surgery, Molengracht 21, 4800 RK, Breda, The Netherlands.
| |
Collapse
|
17
|
Mizobuchi T, Iwai N, Kohno H, Okada N, Yoshioka T, Ebana H. Delayed diagnosis of traumatic diaphragmatic rupture. Gen Thorac Cardiovasc Surg 2009; 57:430-2. [PMID: 19779793 DOI: 10.1007/s11748-009-0418-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Accepted: 01/21/2009] [Indexed: 10/20/2022]
Abstract
We report a case of late presentation of traumatic rupture of the diaphragm discovered incidentally on chest radiography (CXR) during an annual medical checkup. A 60-year-old man suffered severe blunt trauma from heavy steel frames collapsing against his back, resulting in pelvic and femoral fractures as well as pulmonary contusions. The patient recovered, but 10 months later CXR performed for lung cancer surveillance during an annual medical checkup revealed a traumatic rupture of the diaphragm. Video-assisted thoracic surgery was performed with reduction of the intestine and primary closure of the diaphragmatic defect. The patient recovered uneventfully. This report serves as a useful reminder that a medical history of severe blunt trauma should provoke a high index of suspicion for diaphragmatic rupture during annual medical surveillance.
Collapse
Affiliation(s)
- Teruaki Mizobuchi
- Department of Chest Surgery, Matsudo City Hospital, 4005 Kamihongo, Matsudo-shi, Chiba, 271-8511, Japan.
| | | | | | | | | | | |
Collapse
|
18
|
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
|
19
|
Rashid F, Chakrabarty MM, Singh R, Iftikhar SY. A review on delayed presentation of diaphragmatic rupture. World J Emerg Surg 2009; 4:32. [PMID: 19698091 PMCID: PMC2739847 DOI: 10.1186/1749-7922-4-32] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Accepted: 08/21/2009] [Indexed: 11/10/2022] Open
Abstract
Diaphragmatic rupture is a life-threatening condition. Diaphragmatic injuries are quite uncommon and often result from either blunt or penetrating trauma. Diaphragmatic ruptures are usually associated with abdominal trauma however, it can occur in isolation. Acute traumatic rupture of the diaphragm may go unnoticed and there is often a delay between the injury and the diagnosis. A comprehensive literature search was performed using the terms "delayed presentation of post traumatic diaphragmatic rupture" and "delayed diaphragmatic rupture". The diagnostic and management challenges encountered are discussed, together with strategies for dealing with them. We have focussed on mechanism of injury, duration, presentation and site of injury, visceral herniation, investigations and different approaches for repair. We intend to stress on the importance of delay in presentation of diaphragmatic rupture and to provide a review on the available investigations and treatment methods. The enclosed case report also emphasizes on the delayed presentation, diagnostic challenges and the advantages of laparoscopic repair of delayed diaphragmatic rupture.
Collapse
Affiliation(s)
- Farhan Rashid
- Division of GI Surgery, University of Nottingham, Graduate Entry Medical School, Uttoxeter Road, Derby, DE22 3DT, UK.
| | | | | | | |
Collapse
|
20
|
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
|