Co-existence of a rare dyspnea with pericardial diaphragmatic rupture and pericardial rupture: a case report

Case Report: Surgical challenges and insights in a child with a blunt left diaphragmatic and pericardial rupture and heart subluxation

Introduction

Blunt diaphragmatic rupture (BTDR) is a rare condition that can occur in children following high-energy blunt thoracoabdominal trauma. In less than 1% of the cases, pericardial rupture can coexist with a BTDR. A coexistence of BTDR and pericardial rupture can result in displacement of the heart and is associated with high mortality. Clinical presentation is non-specific and requires a high index of suspicion for early management.

Case presentation

A 4-year-old child presented to the emergency unit of our hospital following high-energy trauma with severe respiratory distress. Initially, a left-side chest tube was inserted, but it resulted in no clinical improvement. A chest x-ray showed a collapse of the left lung with a herniation of bowel loops into the left hemithorax. An exploratory laparotomy was done, which revealed a 10 cm × 4 cm defect in the left hemidiaphragm with a medial extension involving the pericardium. The fundus of the stomach and left lobe of the liver were displaced into the pericardial space, pushing the cardiac apex posteriorly to the right side. Concomitantly, the transverse colon and small bowel were displaced into the left pleural space. After the reduction of the herniated abdominal viscera back into the peritoneal cavity, the pericardial sac was repaired by employing an interrupted resorbable suture, while the diaphragmatic defect was repaired by using a horizontal mattress. No other injuries were identified and the abdomen was closed in layers.

Conclusion

BTDR with pericardial rupture is an elusive condition with a high mortality rate that necessitates a high index of clinical suspicion. Early surgical repair of the defect with a reduction of herniated organs can reduce morbidity and mortality.

A Rare Case of Traumatic Pericardio-Diaphragmatic Injury Following a Road Traffic Accident

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.