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Sanchez-Osorio D, Ortega-Claici A, Martínez-Gómez N, Rodríguez-Pérez M. Doctor, Why is my Lung Gurgling? Arch Bronconeumol 2024; 60:529-530. [PMID: 38697902 DOI: 10.1016/j.arbres.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 05/05/2024]
Affiliation(s)
| | | | | | - María Rodríguez-Pérez
- Faculty of Medicine, Universidad de Navarra, Pamplona, Spain; Department of Thoracic Surgery, Clínica Universidad de Navarra, Madrid, Spain
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2
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Sodhi M, Sigley K, Jamil K. Transabdominal Minimally Invasive Repair of a Left Chronic Traumatic Diaphragmatic Hernia. Cureus 2024; 16:e59450. [PMID: 38826886 PMCID: PMC11141322 DOI: 10.7759/cureus.59450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2024] [Indexed: 06/04/2024] Open
Abstract
Although the exact incidence of traumatic diaphragmatic hernia (TDH) is unknown, it can carry significant morbidity if not treated promptly. TDH is thought to be more common in penetrating thoracoabdominal trauma compared to blunt trauma. The left side is thought to be more commonly affected than the right due to the protective effects of the liver on the right hemidiaphragm in trauma. Although large defects are evident on CT imaging and the detection rate is improved with higher resolution CT scanners, smaller ruptures may require laparoscopy for definitive diagnosis if there is a high index of suspicion. In this case report, we present a case of a missed left TDH on CT imaging, with eventual herniation of the omentum and stomach. Although TDH traditionally is approached via thoracotomy or laparotomy, we demonstrate that a transabdominal minimally invasive approach with robot-assisted laparoscopic repair is a viable option, with the potential to reduce the morbidities associated with the open approach.
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Affiliation(s)
- Manjot Sodhi
- General Surgery, Beaumont Hospital, Dearborn, USA
| | - Kevin Sigley
- Bariatric Surgery, University of Rochester, New York, USA
| | - Kevin Jamil
- Thoracic Surgery, Corewell Health, Royal Oak, USA
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3
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Schurr LA, Thiedemann C, Alt V, Schlitt HJ, Götz M, Riedl M, Brunner SM, Popp D. Diaphragmatic Injuries among Severely Injured Patients (ISS ≥ 16)-An Indicator of Injury Pattern and Severity of Abdominal Trauma. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1596. [PMID: 36363553 PMCID: PMC9695598 DOI: 10.3390/medicina58111596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 10/30/2022] [Accepted: 11/02/2022] [Indexed: 12/01/2023]
Abstract
Background and Objectives: Abdominal trauma among severely injured patients with an injury severity score (ISS) of 16 and above can lead to potentially life-threatening injuries that might need immediate surgical intervention. Traumatic injuries to the diaphragm (TID) are a challenging condition often accompanied by other injuries in the thoracoabdominal region. Materials and Methods: We retrospectively analyzed the occurrence and clinical course of TID among severely injured patients treated at our center between 2008 and 2019 and compared them to other groups of severely injured patients without TID. Results: Thirty-five patients with TID and a median ISS of 41 were treated in the period mentioned above. They were predominantly middle-aged men and mostly victims of blunt trauma as a consequence of motor vehicle accidents. A total of 70.6% had left-sided TID, and in 69.6%, the size of defect was larger than 10 cm. The diagnosis was made with computed tomography (CT) in 68.6% of the cases, while in 25.8%, it was made intraoperatively or delayed by a false-negative initial CT scan, and in 5.7%, an intraoperative diagnosis was made without preoperative CT imaging. Surgical repair was mostly conducted via laparotomy, performing a direct closure with continuous suture. A comparison to 191 patients that required laparotomy for abdominal injuries other than TID revealed significantly higher rates of concomitant injuries to several abdominal organs among patients suffering from TID. Compared to all other severely injured patients treated in the same period (n = 1377), patients suffering from TID had a significantly higher median ISS and a longer mean duration of hospital stay. Conclusions: Our findings show that TID can be seen as an indicator of particularly severe thoracoabdominal trauma that requires increased attention from the treatment team so as not to miss relevant concomitant injuries that require immediate intervention.
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Affiliation(s)
- Leonhard Andreas Schurr
- Department of Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Claudius Thiedemann
- Department of Trauma Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany
| | - Hans Jürgen Schlitt
- Department of Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Markus Götz
- Department of Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Moritz Riedl
- Department of Trauma Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany
| | - Stefan Martin Brunner
- Department of Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Daniel Popp
- Department of Trauma Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany
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Surgical management of delayed-presentation diaphragm hernia: A single-institution experience. JTCVS Tech 2022; 13:263-269. [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] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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6
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Identification of Delayed Traumatic Diaphragmatic Injury: A Concise Review. J Trauma Nurs 2022; 29:47-50. [PMID: 35007251 DOI: 10.1097/jtn.0000000000000626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To provide a concise review of the literature on both the difficulty and subtly of identifying a traumatic diaphragmatic hernia in the delayed phase of injury. DATA SOURCES Source data were obtained from PubMed and Open Access Journals. STUDY SELECTION Studies addressing traumatic diaphragmatic injury in the delayed phase of diaphragmatic injury. PubMed was searched using the MeSH term "delayed diaphragmatic rupture." DATA EXTRACTION Relevant studies were reviewed and included on the basis of the preponderance of diaphragmatic injury cases that presented in the delayed phase. The following aspects of each study were identified, abstracted, and analyzed: study population, study design, methods, results, and relevant implications for practice. A few case studies were included to illustrate the importance of a careful medical history and patient evaluation necessary to identify a delayed diaphragmatic hernia presentation. DATA SYNTHESIS Diaphragmatic herniation can occur days and weeks to decades after the initial trauma as a small diaphragmatic tear can evolve into a larger one over time. Follow-up after the acute phase is essential to assess for occult diaphragmatic injury and potential herniation. Meticulous patient history and evaluation are important considerations when the patient presents after the acute phase of injury with vague respiratory or abdominal complaints. During the triage phase of care, trauma nurses have an important role in assessing trauma history. CONCLUSIONS The available evidence suggests that diaphragmatic injury should be on the differential list during and after trauma presentation for both providers and trauma nurses. Other critical injuries may portend a possible diaphragmatic injury. Diaphragmatic injury, though relatively rare, has high morbidity and mortality.
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Paramasivam SJ, Purushothaman S, Al Bshabshe A, Eltaher Osman MJ, Alwadai NM, Sulaiman N, Palanivel O. An unusual presentation of acute diaphragmatic hernia complicated by tension gastrothorax an under-recognized cause of cardiac arrest due to a fall from a height: A case report and literature review. SAGE Open Med Case Rep 2022; 10:2050313X221140241. [DOI: 10.1177/2050313x221140241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/02/2022] [Indexed: 11/29/2022] Open
Abstract
A diaphragmatic hernia is a protrusion of the abdominal contents into the negative pressure thoracic cavity through a congenital or acquired diaphragmatic defect. Generally, acquired diaphragmatic hernia is a rare, life-threatening condition that usually follows blunt/penetrating trauma or an iatrogenic cause, resulting in the diaphragmatic rupture, accompanied by the herniation of abdominal visceral organs. We report a 47-year-old male construction worker who sustained a fall from a height of about 30 feet height. He presented with hypoxia initially and, after a primary survey, was found to have a traumatic rupture of the diaphragm with herniation of the stomach and abdominal contents, causing signs of obstructive shock. After adequate resuscitation in the Emergency Department, he was rushed to operating room. There, he suffered two very short pulseless electrical activity cardiac arrests. Therefore, an emergency anterolateral thoracotomy was done, and it was extended into laparotomy to reduce the abdominal contents through the diaphragmatic tear of 12 cm, which restored the spontaneous circulation. He recovered eventually, despite chest infections and pulmonary atelectasis, and was discharged on the 28th day and remained in good condition during the outpatient visit. Tension gastrothorax or viscerothorax is rare, but an under-recognized cause of cardiac arrest in the trauma setting necessitates a vigilant evaluation and early suspicion to prevent a catastrophic outcome. This case report emphasizes the inclusion of tension viscero or abdominal thorax as one of the recognizable causes of a pulseless electrical activity cardiac arrest.
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Affiliation(s)
| | - Senthil Purushothaman
- Dean, Chettinad School of Physiotherapy, Chettinad Hospital and Research Institute (CHRI), Chettinad Academy of Research and Education (CARE), Kelambakkam, India
| | - Ali Al Bshabshe
- Intensive Care Consultant, Aseer Central Hospital & Professor, Department of Medicine/Critical Care, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | | | - Nasser Mohammed Alwadai
- Consultant Respiratory Therapist, Department of Respiratory Care, Intensive Care unit, Aseer Central Hospital, Abha, Saudi Arabia
| | - Naif Sulaiman
- Consultant Respiratory Therapist, Department of Respiratory Care, Intensive Care unit, Aseer Central Hospital, Abha, Saudi Arabia
| | - Omprakash Palanivel
- Research Scholar, Chettinad School of Physiotherapy, Chettinad Hospital and Research Institute (CHRI), Chettinad Academy of Research and Education (CARE), Kelambakkam, India
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Theodorou CM, Jackson JE, Beres AL, Leshikar DE. Blunt Traumatic Diaphragmatic Hernia in Children: A Systematic Review. J Surg Res 2021; 268:253-262. [PMID: 34392178 DOI: 10.1016/j.jss.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/25/2021] [Accepted: 07/12/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Traumatic diaphragmatic hernia (TDH) is rare in children, most often occurring following blunt thoracoabdominal trauma from high energy mechanisms, such as motor vehicle collisions (MVC). We performed a systematic review to describe injury details and management. METHODS Following PRISMA guidelines, a systematic literature search was performed to identify publications of blunt TDH in patients < 18 y old. Conflicts were resolved by consensus. Data were collected on demographics, TDH location, mechanism of injury, associated intraabdominal injuries (IAI), management, and outcomes. Denominators vary depending on number of patients with such information reported. RESULTS Fifty-eight articles were reviewed with 142 patients with TDH. The median age was seven y (range 0.25-16). Most were left-sided (85 of 126, 67.5%). MVC was the most common mechanism (66 of 142, 46.5%). IAI was present in 50.0% (57 of 114), most commonly liver injuries (25 of 57, 43.9%). Delayed diagnoses occurred in 49.6% (57 of 115, range 8 h-10 y), and were more common with right-sided TDH (76.0% versus 48.5%, P = 0.02). Chest radiography was 59.0% sensitive for TDH, while computed tomography sensitivity was 65.8%. Operative repair was performed on all surviving patients, and all underwent primary diaphragm repair. The overall mortality was 11.3% (n = 16), with four attributable to the TDH. There were no reported recurrences over a median follow-up of 12 mo. CONCLUSIONS Pediatric TDH is a rare diagnosis with a high rate of associated IAI and delayed diagnosis. Primary diaphragm repair was performed in all cases. Surgeons should maintain a high suspicion for diaphragm injury in blunt thoracoabdominal trauma.
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Affiliation(s)
- Christina M Theodorou
- Department of Surgery, Division of Pediatric General, Thoracic, and Fetal Surgery, University of California Davis Medical Center, Sacramento, California.
| | - Jordan E Jackson
- Department of Surgery, Division of Pediatric General, Thoracic, and Fetal Surgery, University of California Davis Medical Center, Sacramento, California
| | - Alana L Beres
- Department of Surgery, Division of Pediatric General, Thoracic, and Fetal Surgery, University of California Davis Medical Center, Sacramento, California
| | - David E Leshikar
- Department of Surgery, Division of Trauma, Acute Care, and Surgical Critical Care, University of California Davis Medical Center, Sacramento, California
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9
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Mindaye ET, Zegeye A. Massive left hemothorax following left diaphragmatic and splenic rupture with visceral herniation: A case report. Int J Surg Case Rep 2020; 78:4-8. [PMID: 33310468 PMCID: PMC7736767 DOI: 10.1016/j.ijscr.2020.11.144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 11/28/2020] [Accepted: 11/29/2020] [Indexed: 11/29/2022] Open
Abstract
Massive hemothorax due to splenic rupture is exceedingly rare. Delayed or missed diagnosis of massive hemothorax due to splenic rupture is fatal. Isolated diaphragmatic injury is very rare. Diaphragmatic rupture signifies underlying serious injuries.
Background Massive left hemothorax following left diaphragmatic and splenic rupture with visceral herniation is quite an uncommon life-threatening condition usually associated with blunt thoracoabdominal trauma. Mortality is generally associated with coexistent vascular and visceral injuries that could be rapidly fatal. Timely, and proper diagnosis is mandatory as survival depends on prompt diagnosis and treatment. Presentation of case We describe a case of massive left hemothorax secondary to blunt thoracoabdominal injury with left diaphragmatic and splenic rupture, gastric, greater omentum and splenic herniation into the left thoracic cavity in a 32 years old male car driver after sustaining a road traffic accident and presented with shortness of breath of 4 h’ duration. He also had zone 3 retroperitoneal hematoma and left acetabular fracture. He was treated surgically and discharged home improved. Discussion Diaphragmatic ruptures following blunt injuries are larger leading to herniation of visceral organs into the thoracic cavity and the most common organ to herniate on the left side is the stomach followed by omentum and small intestine. Splenic rupture is a very rare cause of hemothorax and is often missed in the differential diagnosis. Conclusion Massive hemothorax following splenic and diaphragmatic rupture with visceral herniation following either blunt or penetrating trauma is rare. Delayed or missed diagnosis is associated with higher morbidity and mortality. A high index of suspicion and proper use of diagnostic studies are crucial for early and correct diagnosis.
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Affiliation(s)
- Esubalew Taddese Mindaye
- Department of Surgery, Saint Paul's Hospital Millennium Medical College, Swaziland Street, 1271 Addis Ababa, Ethiopia.
| | - Abraham Zegeye
- Department of Surgery, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
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10
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Marzban‐Rad S, Sattari P, Taheri HR. Delayed presentation of left traumatic diaphragmatic hernia with displacement of spleen and stomach to left hemi thorax. Clin Case Rep 2020; 8:3260-3263. [PMID: 33363917 PMCID: PMC7752465 DOI: 10.1002/ccr3.3405] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/10/2020] [Accepted: 09/20/2020] [Indexed: 11/12/2022] Open
Abstract
We presented a case of late onset of left traumatic diaphragmatic hernia with displacement of spleen and stomach to the left hemi thorax, a year after the trauma. Gastric and respiratory complications along with herniation should be immediately managed, in order to reduce the risk of cardiac arrest and mortality.
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Affiliation(s)
- Saeid Marzban‐Rad
- Department of Thoracic SurgeryImam‐Reza HospitalAja University of Tehran Medical SciencesTehranIran
| | - Parastesh Sattari
- General PractitionerInstitute of Health Education and ResearchChamran hospitalTehranIran
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11
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Bui JT, Browder SE, Wilson HK, Kindell DG, Ra JH, Haithcock BE, Long JM. Does routine uniportal thoracoscopy during rib fixation identify more injuries and impact outcomes? J Thorac Dis 2020; 12:5281-5288. [PMID: 33209362 PMCID: PMC7656410 DOI: 10.21037/jtd-20-2087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Flail chest and severely displaced rib fractures due to blunt trauma can be associated with intrathoracic injuries. At our institution, two thoracic surgeons perform all surgical stabilization of rib fractures (SSRF): one performs routine uniportal thoracoscopy (R-VATS) at the time of SSRF and the other for only select cases (S-VATS). In this pilot study, we hypothesized that R-VATS at the time of SSRF identifies and addresses intrathoracic injuries not seen on imaging and may impact patient outcomes. Methods A retrospective review of all patients who underwent SSRF from 2013–2019 at our institution was performed for severely displaced rib fractures or flail chest. Data collected included demographics, imaging results, treatment strategy, and operative findings. Results Ninety-nine patients underwent SSRF. Uniportal thoracoscopy was performed on 69% of these patients. When thoracoscopy was performed, 31 additional injuries were identified. R-VATS identified 23 additional intrathoracic findings at time of thoracoscopy not seen on CT scan compared to 8 findings in the S-VATS group (P=0.367). At 3 months follow-up, one empyema and one diaphragmatic hernia required reoperation—neither of which underwent thoracoscopy at time of SSRF. There were no differences in LOS, operative times, and overall mortality between the SSRF/thoracoscopy and SSRF only groups. Conclusions R-VATS at the time of SSRF did not identify a statistically significant greater number of occult intrathoracic injuries compared to S-VATS. R-VATS was not associated with increased operative time, LOS, and mortality. Further study is needed to determine if there is benefit to R-VATS in patients meeting requirements for rib fracture repair.
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Affiliation(s)
- Jenny T Bui
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Sydney E Browder
- Department of Surgery, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Hadley K Wilson
- University of North Carolina School of Medicine, Chapel Hill, NC, USA.,Department of Surgery, Division of Cardiothoracic Surgery, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Daniel G Kindell
- University of North Carolina School of Medicine, Chapel Hill, NC, USA.,Department of Surgery, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Jin H Ra
- University of North Carolina School of Medicine, Chapel Hill, NC, USA.,Department of Surgery, Division of Trauma Surgery, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Benjamin E Haithcock
- University of North Carolina School of Medicine, Chapel Hill, NC, USA.,Department of Surgery, Division of Cardiothoracic Surgery, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Jason M Long
- University of North Carolina School of Medicine, Chapel Hill, NC, USA.,Department of Surgery, Division of Cardiothoracic Surgery, University of North Carolina Hospitals, Chapel Hill, NC, USA
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12
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Mohandas P, Krim AOA, Glenn J. Clinicoradiological diagnosis: Cough-induced transdiaphragmatic intercostal herniation. BJR Case Rep 2020; 6:20190061. [PMID: 33029361 PMCID: PMC7527000 DOI: 10.1259/bjrcr.20190061] [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: 06/18/2019] [Revised: 10/22/2019] [Accepted: 11/13/2019] [Indexed: 12/02/2022] Open
Abstract
Transdiaphragmatic intercostal herniation can occur following blunt or penetrating trauma and is usually associated with rib fractures. It is uncommon and only sporadically reported in literature. We report a case of cough-induced intercostal herniation containing large bowel, on a background of sustaining a blunt chest trauma 25 years prior to presentation. The patient was treated by reducing the hernia followed by surgical repair of the diaphragm and intercostal muscles defect. He was discharged without further complications and remained well at follow-up.
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Affiliation(s)
- Prema Mohandas
- Department of Surgery, Southland Hospital, Kew Road, 9812, Invercargill, Southland, New Zealand
| | - Ahmed O A Krim
- Department of Radiology, Waikato District Health Board, Pembroke Street, Private Bag 3200, Hamilton 3240, New Zealand
| | - Jerry Glenn
- Department of Surgery, Southland Hospital, Kew Road, 9812, Invercargill, Southland, New Zealand
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13
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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]
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14
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Left diaphragmatic hernia following thoracoabdominal aortic repair: A case report. Int J Surg Case Rep 2020; 70:209-212. [PMID: 32417740 PMCID: PMC7229409 DOI: 10.1016/j.ijscr.2020.04.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/11/2020] [Accepted: 04/24/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Diaphragmatic hernias are somewhat rare complications of thoracoabdominal interventions. Given their late clinical manifestations and misdiagnosis, their incidence is unknown. These hernias have a high mortality risk when an emergency intervention is warranted due to complications from visceral strangulation. CASE PRESENTATION We present the case of a 67-year-old male with prior history of thoracoabdominal aortic repair, who reconsults due to upper gastrointestinal bleeding. Upon arrival, imaging shows a left diaphragmatic herniation with migration of the stomach, omentum and spleen to the thoracic cavity. Through laparoscopic approach, a left diaphragmatic hernial defect is identified with protrusion of half the stomach, omentum and the posterior aspect of the spleen with a sub capsular tear. Additionally, a severe adhesion syndrome on the chest wall and diaphragm were also evident, with entrapment of the inferior lobe of the left lung. The contents were successfully reduced, however pulmonary decortication and extensive adhesiolysis through thoracoscopy was required for complete extraction, enabling a primary repair without tension. CONCLUSIONS We present an infrequent pathology without an established incidence, which has relevant clinical and surgical implications at any level of care, in this case requiring interdisciplinary management. The suspicion of diaphragmatic hernia in a patient with past medical history of thoracoabdominal aortic repair with non-specific gastrointestinal symptoms is essential. We emphasize the importance of clinical suspicion of this complication once the surgical precedent has been identified.
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15
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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.
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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
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16
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Gu P, Lu Y, Li X, Lin X. Acute and chronic traumatic diaphragmatic hernia: 10 years' experience. PLoS One 2019; 14:e0226364. [PMID: 31830097 PMCID: PMC6907826 DOI: 10.1371/journal.pone.0226364] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 11/24/2019] [Indexed: 11/19/2022] Open
Abstract
Controversy persists regarding many aspects of traumatic diaphragmatic hernia (TDH). We aimed to understand why some traumatic diaphragmatic injuries present with chronic hernia and to evaluate diagnosis and treatment options. Fifty acute and 19 chronic TDH patients were diagnosed and treated at our institution over a 10-year period. Clinical data from these two groups were analyzed statistically and compared. Chronic TDH patients had a significantly lower Injury Severity Score than acute TDH patients (10.26 ± 2.68 vs. 26.92 ± 4.79, P < 0.001). The most common surgical approach for acute and chronic TDH was thoracotomy and laparotomy, respectively. The length of the diaphragmatic rupture was significantly shorter in chronic TDH patients than acute TDH patients (6.00 ± 1.94 cm vs. 10.71 ± 3.30 cm, P < 0.001). The mean length of hospital stay was significantly longer for acute TDH patients than chronic TDH patients (41.18 ± 31.02 days vs. 16.65 ± 9.61 days, P = 0.002). In conclusion, milder trauma and a smaller diaphragmatic rupture were associated with delayed diagnosis. A thoraco-abdominal computed tomography scan is needed for patients with periphrenic injuries to avoid delayed diagnosis of TDH. Improved awareness and understanding of diaphragmatic injuries will increase the rate of early diagnosis and improve prognosis.
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Affiliation(s)
- Pengcheng Gu
- Trauma centre, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yang Lu
- Trauma centre, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xigong Li
- Department of Orthopedics, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiangjin Lin
- Trauma centre, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Gribben JL, Ilonzo N, Neifert S, Forleiter C, Leitman IM. Patient Characteristics and Outcomes Following Operative Repair of Acute versus Chronic Traumatic Diaphragmatic Hernia. JOURNAL OF SCIENTIFIC INNOVATION IN MEDICINE 2019. [DOI: 10.29024/jsim.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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18
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Elbanna KY, Mohammed MF, Huang SC, Mak D, Dawe JP, Joos E, Wong H, Khosa F, Nicolaou S. Delayed manifestations of abdominal trauma: follow-up abdominopelvic CT in posttraumatic patients. Abdom Radiol (NY) 2018; 43:1642-1655. [PMID: 29051983 DOI: 10.1007/s00261-017-1364-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE Our study aims to investigate the frequency and patterns of delayed manifestations of abdominal and pelvic injuries which may not be identified or which fail to manifest on the initial abdominopelvic CT in posttraumatic patients. METHODS For our institutional review board (IRB)-approved retrospective study, our hospital trauma registry was queried for patients with blunt multitrauma and Injury Severity Score (ISS) ≥ 16 between January 2010 and August 2016, yielding 3735 patients. A total of 203 patients received a follow-up abdominopelvic CT within six months from the initial scan and those with new findings on follow-up CT were identified. A retrospective blinded review of the initial CT examinations was performed by two experienced radiologists. The retrospective readings and original reports were compared to categorize the new abnormalities detected on follow-up CT scans. The categories included missed injuries, late presentations and sequelae of trauma, and complications of surgery, hospital admission, and invasive procedures. The patients' notes were reviewed for the clinical indications, time interval for repeat CT examination, and subsequent clinical management. The software used for statistical analysis of the extracted data was Microsoft Excel for Mac (version 15.33). RESULTS Out of 3735 patients, 203 patients received 232 follow-up abdominopelvic CTs. The average elapsed time between the initial CT and the follow-up CT was 15 ± 27 days. Evaluation for an abdominal fluid collection was the most common clinical indication, accounting for 40% of the total number (n = 243) of indications. Delayed manifestations and complications of trauma were present in 41 patients due to 47 abnormalities, most commonly related to solid organ injury, followed by abdominal collections and hematoma. Twenty-nine CT findings (62%) were only detectable on follow-up CT, while nine injuries (19%) were missed on initial CT. The findings on repeated CT warranted eight surgical and 15 interventional procedures. CONCLUSION A small percentage of traumatic injuries may be unidentified or fail to manifest on the initial CT, resulting in delayed manifestations of abdominopelvic trauma, which may lead to subsequent readmission, delayed management, and more severe medical complications.
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Affiliation(s)
- Khaled Y Elbanna
- Emergency & Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada.
- , Toronto, ON, Canada.
| | - Mohammed F Mohammed
- Emergency & Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Shih-Chieh Huang
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - David Mak
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - J Philip Dawe
- Trauma Services, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Emilie Joos
- Trauma Services, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Heather Wong
- Trauma Services, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Faisal Khosa
- Emergency & Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Savvas Nicolaou
- Emergency & Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
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Upper Gastrointestinal Bleeding as Delayed Presentation of Traumatic Diaphragmatic Hernia; a Case Report. ADVANCED JOURNAL OF EMERGENCY MEDICINE 2018; 2:e36. [PMID: 31172099 PMCID: PMC6549205 DOI: 10.22114/ajem.v0i0.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Introduction: Traumatic diaphragmatic hernia (TDH) is one of the critical complications resulting from penetrating chest trauma. The rate of undiagnosed TDH equivocates 12-60%. The significant part of complications happens 1-4 years after the primary damage. Here, we report a case of delayed TDH presented with upper gastrointestinal bleeding (GIB) as an excuse to discuss this issue. Case presentation: The patient was a 35-year-old man, admitted with objection of abdominal pain. A nasogastric tube was inserted and fixed that resulted in drainage of about 500cc dark blood. He was candidate for emergent endoscopy due to upper GIB. During resuscitation measures, he suddenly developed respiratory distress that could not be justified by upper GIB alone. Therefore, bedside sonography discovered some soft tissue apart from lung tissue in the left hemithorax. After performing diagnostic measures, with diagnosis of diaphragmatic herniation and strangulation he underwent emergent surgery. Conclusion: Small diaphragmatic lesions, which usually result from stab wounds, may develop into larger injuries if left untreated and they might lead to a diaphragmatic hernia with a potential risk of early or late complications and mortality. One of the rare complications is GIB, which should be considered in a patient with past history of trauma and presentation of GIB.
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20
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Delayed Presentation of Posttraumatic Diaphragmatic Hernia Masquerading as Recurrent Acute Asthmatic Attack. Case Rep Med 2017; 2017:5037619. [PMID: 29056971 PMCID: PMC5625800 DOI: 10.1155/2017/5037619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/19/2017] [Indexed: 11/17/2022] Open
Abstract
Diaphragmatic hernia following blunt abdominal injury is extremely rare and often diagnosed late. Missed diagnosis is also common with this condition. We herein present a delayed presentation of diaphragmatic hernia following blunt abdominal injury that was initially misdiagnosed as recurrent acute asthmatic attack due to repeated presentation with episodic difficulty in breathing.
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21
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Bonatti M, Lombardo F, Vezzali N, Zamboni GA, Bonatti G. Blunt diaphragmatic lesions: Imaging findings and pitfalls. World J Radiol 2016; 8:819-828. [PMID: 27843541 PMCID: PMC5084060 DOI: 10.4329/wjr.v8.i10.819] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/31/2016] [Accepted: 08/29/2016] [Indexed: 02/06/2023] Open
Abstract
Blunt diaphragmatic lesions (BDL) are uncommon in trauma patients, but they should be promptly recognized as a delayed diagnosis increases morbidity and mortality. It is well known that BDL are often overlooked at initial imaging, mainly because of distracting injuries to other organs. Sonography may directly depict BDL only in a minor number of cases. Chest X-ray has low sensitivity in detecting BDL and lesions can be reliably suspected only in case of intra-thoracic herniation of abdominal viscera. Thanks to its wide availability, time-effectiveness and spatial resolution, multi-detector computed tomography (CT) is the imaging modality of choice for diagnosing BDL; several direct and indirect CT signs are associated with BDL. Given its high tissue contrast resolution, magnetic resonance imaging can accurately depict BDL, but its use in an emergency setting is limited because of longer acquisition times and need for patient’s collaboration.
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Ghionzoli M, Bongini M, Piccolo RL, Martin A, Persano G, Deaconu DE, Messineo A. Role of thoracoscopy in traumatic diaphragmatic hernia. Pediatr Int 2016; 58:601-3. [PMID: 27072876 DOI: 10.1111/ped.12887] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 09/17/2015] [Accepted: 11/04/2015] [Indexed: 11/30/2022]
Abstract
Thoraco-abdominal trauma can in rare cases involve diaphragmatic rupture and subsequent herniation of intra-abdominal contents. We report a case of this complication in a 5-year-old boy who was injured in a car crash, and who manifested respiratory distress and hemodynamic instability after 48 h of being monitored in the pediatric intensive care unit. Multiple radiologic investigations were inconclusive and the definite diagnosis was established only on thoracoscopic exploration.
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Affiliation(s)
- Marco Ghionzoli
- Department of Emergency, Critical Area and Pediatric Surgery, University of Florence and Children's University Hospital "A. Meyer", Florence, Italy
| | - Martina Bongini
- Department of Emergency, Critical Area and Pediatric Surgery, University of Florence and Children's University Hospital "A. Meyer", Florence, Italy
| | - Roberto Lo Piccolo
- Department of Emergency, Critical Area and Pediatric Surgery, University of Florence and Children's University Hospital "A. Meyer", Florence, Italy
| | - Alessandra Martin
- Department of Emergency, Critical Area and Pediatric Surgery, University of Florence and Children's University Hospital "A. Meyer", Florence, Italy
| | - Giorgio Persano
- Department of Emergency, Critical Area and Pediatric Surgery, University of Florence and Children's University Hospital "A. Meyer", Florence, Italy
| | - Diana E Deaconu
- Department of Emergency, Critical Area and Pediatric Surgery, University of Florence and Children's University Hospital "A. Meyer", Florence, Italy
| | - Antonio Messineo
- Department of Emergency, Critical Area and Pediatric Surgery, University of Florence and Children's University Hospital "A. Meyer", Florence, Italy
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23
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Abdullah M, Stonelake P. Tension pneumothorax due to perforated colon. BMJ Case Rep 2016; 2016:bcr-2016-215325. [PMID: 27247208 DOI: 10.1136/bcr-2016-215325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A very rare case of traumatic diaphragmatic hernia is reported in a 65-year-old woman who presented 46 years after her initial thoracoabdominal injury with tension faecopneumothorax caused by a perforated colon in the chest cavity. She presented in a critical condition with severe respiratory distress, sepsis and acute kidney injury. She had a long-standing history of bronchial asthma with respiratory complications and had experienced progressive shortness of breath for the past year. A recent CT scan had excluded the presence of a diaphragmatic hernia but showed a significantly raised left hemidiaphragm. On admission, chest X-rays showed a significantly raised left hemidiaphragm and mediastinal shift, but the possibility of a diaphragmatic hernia with strangulated bowel in the chest was not suspected until the patient was reviewed by the surgical and intensive care unit consultants the next morning and a repeat CT performed. She had a successful outcome after her emergency operation.
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Affiliation(s)
- Muhammad Abdullah
- Department of General Surgery, The Dudley Group NHS Foundation Trust, Dudley, UK
| | - Paul Stonelake
- Department of General Surgery, Russells Hall Hospital, Dudley, UK
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Delayed Traumatic Diaphragmatic Hernia With Bacterial Pleuritis. Int Surg 2016. [DOI: 10.9738/intsurg-d-15-00262.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Thoraco-abdominal blunt trauma may cause traumatic diaphragmatic hernia. Here, we report a case of delayed traumatic diaphragmatic rupture with herniation of multiple viscera along with bacterial pleuritis without perforation or necrosis. A 72-year-old man presented with severe left-sided chest pain and dyspnea following a fall in the bathroom on the previous day; he had hit the left side and back of the chest against a faucet. Computed tomography (CT) revealed pneumoderma, mediastinal emphysema, pneumothorax, and fractures of the 8th–11th left ribs. We diagnosed traumatic pneumothorax, which was treated by a thoracostomy tube inserted into the pleural space. Approximately 6 months later, he presented again with fever (39.2°C), dyspnea, and coughing. The white blood cell count and C-reactive protein were elevated at 20.3 × 103/μL and 28.7 mg/dL, respectively. A CT scan revealed left-sided pleural effusion and diaphragmatic hernia. Thoracocentesis was performed for the pleural effusion, and bacterial cultivation tests revealed Bacteroides fragilis; therefore, antibiotics were administered for 3 weeks. Subsequently, diaphragmatic hernia repair was performed. Laparotomy via a left subcostal incision revealed a defect measuring 60 × 60 mm; this was repaired with uninterrupted absorbable sutures without using a hernia mesh to avoid infection. The postoperative course was uneventful, and no recurrence was noted at the 1-year follow-up. We repaired delayed traumatic diaphragmatic rupture with herniation of multiple viscera by simple suturing without using a hernia mesh following the treatment of associated bacterial pleuritis.
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Co-existence of a rare dyspnea with pericardial diaphragmatic rupture and pericardial rupture: a case report. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 12:173-5. [PMID: 26336505 PMCID: PMC4550023 DOI: 10.5114/kitp.2015.52865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 04/02/2014] [Accepted: 06/23/2014] [Indexed: 11/17/2022]
Abstract
Pericardial-diaphragmatic rupture is a rare condition which occurs after blunt trauma and involves the herniation of abdominal organs into the pericardium. A 77-year-old female patient presenting with complaints of palpitation and difficulty in breathing was admitted to the emergency room. Left lateral thoracotomy revealed the herniation of abdominal organs into the thorax. A pericardial-diaphragmatic rupture and a pericardial rupture were found to co-exist. The diaphragm and the pericardium were repaired primarily. The case is presented here because herniation of abdominal organs into the pleural cavity through the pericardium is a rare condition.
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