Gastric Incarceration and Perforation following Posttraumatic Diaphragmatic Hernia

Late traumatic diaphragmatic rupture complicated by haemothorax and strangulation of the stomach: A case report

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.

Emergency surgery due to diaphragmatic hernia: case series and review

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.

Gastric traumatic injuries: CT findings

OBJECTIVE

Gastric blunt traumatic injuries are uncommon and their radiological appearance has been infrequently reported in medical literature. These injuries are difficult to diagnose preoperatively, though they require immediate recognition to minimize their otherwise high mortality and morbidity. The aim of our study is to describe the radiological appearance of blunt gastric traumatic injuries.

MATERIALS AND METHODS

Retrospective evaluation of a 25 patients series observed between January 1997 and May 2005.

RESULTS

We observed rupture of the stomach in 20% of cases, in 44% of cases a partial lesion of the stomach, in one case a necrotic post-traumatic volvulus, five patients (20%) had benign portal pneumatosis, in three patients the stomach was secondarily involved because of a diaphragmatic hernia. The fundus resulted to be the most frequently damaged part of the stomach (80%).

CONCLUSIONS

Blunt traumatic injuries need a careful and systematic approach given their economical and social relevance. For these reasons uncommon lesions require attention and may be important to search for specific findings of gastric lesions.