Tdh occurs mostly in blunt trauma, and less frequently in penetrating injuries. A diaphragmatic hernia and pericardial rupture caused by. Traumatic diaphragmatic hernia article pdf available in indian journal of surgery 702. A traumatic diaphragmatic hernia is caused as a result from blunt or penetrating trauma and occurs in about 5% of cases of severe blunt trauma to the trunk.
Mccrackin stevenson, dvm, phd, dacvs department of small animal clinical sciences, college of veterinary medicine, university of tennessee, knoxville, tn 379011071. The hernia was on the right side in 2 patients, the left side in 1, and was bilateral in 1. With an increase in natural disasters and accidents, blunt traumatic diaphragmatic hernia incidence will continue to increase and those managing trauma injuries must be alert to the possibility of pericardial injury. Laparoscopic repair of delayed traumatic diaphragmatic hernia with mesh cihan agalar 1, sami benli 1, tufan egeli 1, mucahit ozbilgin 1 and isil basara 2 1 department of general surger y, school of medicine, dokuz eylul university, izmir, turkey. Traumatic diaphragmatic hernia in childhood sciencedirect. A defect in the diaphragm of the fetus allows one or more of their abdominal.
A high index of suspicion is still a safeguard against missing this injury. The patients were analyzed as to the mode of trauma, location of the diaphragmatic injury and associated injuries, and the time and methods of diagnosis. Delayed recognition of tdi resulting in diaphragmatic hernia is problematic due to the associated morbidity and mortality. Like the authors, we found that the diagnosis of blunt trau. The problems of radiodiagnosis are outlined and the need for barium contrast studies of the entire gastrointestinal tract to ensure recognition of isolated small bowel herniation is emphasized. Traumatic diaphragmatic hernia is the type chiefly responsible for the complications of alimentary canal obstruction, strangulation and acute massive herniation.
The stomach and colon are the organs most commonly found within the chest 3, 6 due to their mobility and proximity to the diaphragm. Aug 12, 2016 traumatic diaphragmatic hernias tdhs are sometimes difficult to identify at an early stage and can consequently result in diagnostic delays with lifethreatening outcomes. It occurs in 5% of hospitalized automobile accident victims and 10% of victims of penetrating chest trauma. Diaphragm injuries are diagnosed in the acute phase of blunt trauma only in 10% of casesmore often they are presented as hernia.
Traumatic diaphragmatic hernia was rightsided in 5 27. Patients can be asymptomatic in up to 53% of hernias from blunt trauma and 44. Left kidney and intestinals coils were found to herniate through the diaphragmatic tear. Pdf laparoscopic repair of traumatic diaphragmatic hernia. The article published in chest by seelig and associates january 19991 on a very rare complication of occult diaphrag matic hernia has an important theoretical and practical value. Traumatic diaphragmatic hernias tdhs are sometimes difficult to identify at an early stage and can consequently result in diagnostic delays with lifethreatening outcomes. Traumatic diaphragmatic hernias may further be subdivided into those which are caused by direct trauma to the diaphragm and those caused by indirect trauma. Laparoscopic repair of traumatic diaphragmatic hernia. Tension fecopneumothorax due to colonic perforation in a diaphragmatic hernia. Traumatic diaphragmatic hernia is an uncommon but important problem in the patient with multiple injuries. A 6yearold boy presented to the hospital after several hours of vomiting and dyspnea. We report a case of delayed presentation of traumatic diaphragmatic hernia on the left side in a 44yearold male who presented two weeks after a minor blunt trauma. Delayed presentation of traumatic diaphragmatic rupture.
Delayed presentation of traumatic diaphragmatic rupture with. Gordon bryans study 1921 of both types of injury is a surgical. This report describes the clinical findings and supportive and operative management in four children with traumatic diaphragmatic hernia. Twenty nine patients underwent surgery for traumatic diaphragmatic hernia. Diaphragmatic rupture also called diaphragmatic injury or tear is a tear of the diaphragm, the muscle across the bottom of the ribcage that plays a crucial role in respiration. Early diagnosis of traumatic diaphragmatic hernia is necessary to decrease morbidity and mortality associated with it. Abdominal trauma is frequently encountered, but traumatic injuries to the diaphragm are often missed. Diaphragmatic hernias require a high level of suspicion to detect. The patients were analyzed as to the mode of trauma, location of the diaphragmatic injury and associated injuries.
Traumatic rupture of the diaphragm is a condition which has assumed greatly increased clinical significance in the past quartercentury, when roentgen diagnosis and improved anesthetic and surgical techniques have made treatment successful with some degree of regularity. Article traumatic diaphragmatic hernia applied radiology. Traumatic diaphragmatic hernia occurs in less than 50% of the patients with diaphragmatic injuries. The report of coppinger 17 illustrates this problem. Delayed presentation of post traumatic diaphragmatic hernia. Delayed presentation of traumatic rightsided diaphragmatic. Ambroise par6, in 1579, described the first case of diaphragmatic rupture diagnosed at autopsy. Traumatic diaphragmatic hernia has always been a diagnostic challenge to both the radiologist and surgeon. Traumatic diaphragmatic hernia the annals of thoracic surgery. Average age of the patients was 30 years and the female to male ratio was 4.
Delayed presentation of posttraumatic diaphragmatic hernia. Laparoscopic repair of delayed traumatic diaphragmatic hernia. Among these cases, traumatic diaphragmatic hernia is a relatively uncommon injury. Spontaneous acquired diaphragmatic hernia without any apparent history of trauma is a very rare condition and is very difficult to diagnose figure 2. Riolfi performed the first successful repair in 1886. Evaluation and management of traumatic diaphragmatic injuries.
Pdf traumatic diaphragmatic hernia challenging diagnosis and. The mechanism of diaphragmatic tear with blunt trauma is described and modes of diagnosis and treatment are discussed. Strangulated traumatic diaphragmatic hernia simulating a subphrenic abscess. Request pdf laparoscopic repair of traumatic diaphragmatic hernia posttraumatic diaphragmatic rupture or eventration is still a challenging problem. Diaphragmatic injuries are quite uncommon and often result from either blunt or penetrating trauma. Traumatic diaphragmatic hernia the annals of thoracic. Traumatic diaphragmatic hernia bryer 1978 bjs british.
Traumatic diaphragmatic hernia can present immediately following injury, but may be overlooked in the urgency to evaluate and treat patients with multiple trauma. The definition of diaphragmatic hernia requires the protrusion of abdominal viscera through a congenital or acquired opening in the diaphragm into the thorax. The frequency of motor vehicle accidents and injuries resulting from physical violence calls for an increased awareness of the possibility of traumatic diaphragmatic hernia in the acutely injured patient. Multiple imaging modalities are available to evaluate the diaphragm following trauma. Thoracoscopy as an aid to the diagnosis of diaphragmatic injury in penetrating wounds of the left lower chest.
Rupture of the diaphragm mostly occurs following major trauma. The diagnostic and management challenges encountered are discussed, together with strategies for dealing with them. Laparoscopic repair of delayed traumatic diaphragmatic. However, with the proper training and equipment, most of these hernias are amenable to laparoscopic approach. Traumatic diaphragmatic hernia presents unique obstacles to a minimal invasive approach. The entity of diaphragmatic rupture post trauma was first described by sennertus in 1541. The article published in chest by seelig and associates january 19991 on a very rare complication of occult diaphragmatic hernia has an important theoretical and practical value.
Since diaphragmatic injuries are difficult to diagnose, those that are missed may present with latent. It is believed that left traumatic diaphragmatic hernias are more common as a result of the protective rightsided anatomic lie of the liver. Congenital diaphragmatic hernia cdh is defined by the presence of an orifice in the diaphragm, more often left and posterolateral that permits the herniation of abdominal contents into the thorax. Pdf laparoscopic repair of traumatic diaphragmatic. The traumatic diaphragmatic hernia diagnosis is based. This case demonstrates the importance of considering the diagnosis in all. Nov 30, 2017 diaphragmatic hernia is a condition in which there is an abnormal opening in the diaphragm which results in one or more abdominal structures to protrude through this opening into the chest cavity resulting in a variety of symptoms. Traumatic herniation of abdominal contents through a tear or rupture of the central or posterior aspect of the hemidiaphragm may follow blunt thoracoabdominal trauma. Congenital diaphragmatic hernia cdh is defined by the presence of an orifice in the diaphragm, more often left and posterolateral that permits the herniation of.
A congenital diaphragmatic hernia cdh is due to the abnormal development of the diaphragm while the fetus is forming. Havard from sully hospital, glamorgan received for publication february, 1961 rupture of the diaphragm and herniation of the abdominal viscera into the chest are wellrecognized results of crushing or penetrating injuries. An often overlooked form of traumatic diaphragmatic hernia is the one that complicates operative procedures on the diaphragm. If unrecognized, traumatic diaphragmatic injuries are subject to enlarge over time as.
Traumatic diaphragmatic hernia challenging diagnosis and. Evaluation and management of traumatic diaphragmatic. A traumatic right diaphragmatic rupture is an uncommon condition, as it occurs in 0. Diaphragmatic rupture can result from blunt or penetrating trauma and occurs in about 5% of cases of severe blunt trauma to the trunk. Since diaphragmatic injuries are difficult to diagnose. Traumatic diaphragmatic hernias are rare and challenging to diagnose. The incidence of tdh in trauma patients is around 0.
One of the largest contemporary case series of post traumatic diaphragmatic hernia tdh was published by murray et al. Early diagnosis and management of traumatic diaphragmatic hernia tdhcan be challenging for the emergency. Traumatic diaphragmatic disruption is a common injury and a marker of severe trauma. Pdf delayed presentation of posttraumatic diaphragmatic. It is challenging to find the diagnosis immediately and is illustrated by the incidence of 1266% initially missed diagnosis 1. Traumatic diaphragmatic hernia jama surgery jama network. May 01, 2003 traumatic diaphragmatic hernia in cats. Case report a 32 year old male was admitted to the emergency department with a history of nausea, vomiting, pain in the chest and upper abdomen as well as breathlessness. Mccutcheon bl, chin uy, hogan gj 2010 laparoscopic repair of traumatic intrapericardial diaphragmatic hernia. If unrecognized, traumatic diaphragmatic injuries are subject to enlarge over time as a result of the normal. A true hernia requires the presence of a sac composed of a layer of peritoneum within and a layer of pleura without. Most commonly, acquired diaphragmatic tears result from physical trauma. Traumatic diaphragmatic herniaour experience sciencedirect.
Traumatic diaphragm injuries tdi pose both diagnostic. Know the causes, symptoms, diagnosis and treatment of diaphragmatic hernia. Latent traumatic diaphragmatic hernia a surgical challenge to the editor. Abdominal radiography with alteration of the left diaphragmatic contour and presence of airfluid levels. Review of literature a pubmed search was conducted using the terms of post traumatic diaphragmatic rupture. The duration of a diaphragmatic hernia may range from a few hours to years. Traumatic diaphragmatic hernia tdh or rupture is a serious complication of abdominal or thoracic trauma. Young males have historically thought to be more commonly affected. The cause of rupture was blunt trauma in 2483% patients and penetrating trauma in 517% patients. The entity of diaphragmatic rupture posttrauma was first described by sennertus in 1541. It is the aim of this case study to highlight the difficulties encountered with the earlier detection of traumatic diaphragmatic hernias. This is a rare congenital anomaly of the diaphragm that occurs due to poor. There is no breed predisposition for traumatic diaphragmatic hernias. Delayed presentation of traumatic diaphragmatic hernia.
1143 1416 1409 141 447 1366 170 19 1451 540 412 354 975 1289 1226 1171 326 21 217 350 818 1343 382 1266 1206 827 866 1399 1143 1069 167 746 220 303 444