scholarly journals Traumatic Diaphragmatic Rupture, Incidence, Presentation, and Outcome: تمزق الحجاب الحاجز الرضحي؛ مدى شيوع الإصابة والعرض والنتيجة

2021 ◽  
Vol 5 (3) ◽  
pp. 98-84
Author(s):  
Waleed Mohammed Gialan, Yasser Abdurabu Obadiel, Abdulrazzak Waleed Mohammed Gialan, Yasser Abdurabu Obadiel, Abdulrazzak
Keyword(s):  
Prospective Study ◽  
Blunt Trauma ◽  
Diaphragmatic Hernia ◽  
Penetrating Trauma ◽  
Length Of Hospital Stay ◽  
Diaphragmatic Rupture ◽  
Associated Injuries ◽  
Traumatic Diaphragmatic Rupture ◽  
The Right ◽  
Time Of Presentation

Objective: The aim of this prospective study is to highlight the incidence of a traumatic diaphragmatic rupture occurring in thoraco-abdominal penetrating or blunt trauma, and discuss their presentation and outcome Methods: We performed a prospective study, between 1st January 2017 to 30th June 2020 at the Department of General Surgery of the Al-Thawra Modern General Hospital, and 48-Modrn hospital -Sana'a city -Yemen. We included all the patients who were diagnosed and admitted with traumatic diaphragmatic rupture during the study period. Data included demographics, mechanism of injury, associated injuries, time of presentation post- trauma, length of hospital stay and ICU, ventilator days, management, postoperative complication, and outcomes. The variables were analyzed and compared for patients. Result: A total of 38 patients had traumatic diaphragmatic injury of (1843) thoracoabdominal trauma (2.1%)(855 blunt trauma & 988 penetrating trauma), 31 patients (81.6%) have sustained penetrating trauma, while only 7 patients (18.4%) have blunt trauma. There were 33 male patients (86.8%) and 5 female patients (13.2%) with a mean age of 25 years (range 3–52 years), the location of rupture was 30 patients (78.9%) on the left-sided, and 8 patients (21.1%) on right-sided, 4 patients presented early with a diaphragmatic hernia, and 5 patient presented late with diaphragmatic hernia. Associated injuries were presented in 36 patients (94.7%). The diagnosis was preoperatively established in (36.8%), and intraoperative (63.2%). The diaphragmatic rupture was repaired with interrupted nonabsorbable sutures. Postoperative complications were observed in 23 patients (60.5%). Mortality was observed in 4 patients (10.5%). The outcome affected by associated injuries hemo/pneumothorax, rib fractures/lung contusion, hollow viscous injury, post-operative complication, time of presentation post- trauma, and hemodynamically state before admission. Conclusion: Traumatic diaphragmatic rupture, usually masked by multiple associated injuries which aggravate the condition of patients and are responsible for morbidity and mortality. The left-sided is involved more than the right-sided.

scholarly journals Delayed Presentation of Traumatic Diaphragmatic Rupture with Herniation of the Left Kidney and Bowel Loops

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Amiya Kumar Dwari ◽  
Abhijit Mandal ◽  
Sibes Kumar Das ◽  
Sudhansu Sarkar
Keyword(s):  
Blunt Trauma ◽  
Diaphragmatic Hernia ◽  
Major Trauma ◽  
Left Kidney ◽  
Diaphragmatic Rupture ◽  
Delayed Presentation ◽  
Traumatic Diaphragmatic Hernia ◽  
Traumatic Diaphragmatic Rupture ◽  
A Minor

Rupture of the diaphragm mostly occurs following major trauma. We report a case of delayed presentation of traumatic diaphragmatic hernia on the left side in a 44-year-old male who presented two weeks after a minor blunt trauma. Left kidney and intestinals coils were found to herniate through the diaphragmatic tear. This case demonstrates the importance of considering the diagnosis in all cases of blunt trauma of the trunk. It also illustrates the rare possibility of herniation of kidney through the diaphragmatic tear.

scholarly journals Strangulated Tension Viscerothorax with Gangrene of the Stomach in Missed Traumatic Diaphragmatic Rupture

ISRN Surgery ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Uvie Onakpoya ◽  
Akinwumi Ogunrombi ◽  
Anthony Adenekan ◽  
William Akerele
Keyword(s):  
Treatment Outcomes ◽  
Blunt Trauma ◽  
Diaphragmatic Hernia ◽  
Anterior Wall ◽  
Diaphragmatic Rupture ◽  
The Body ◽  
Rare Occurrence ◽  
Traumatic Diaphragmatic Rupture ◽  
Poor Treatment ◽  
Diaphragmatic Hernias

Acquired diaphragmatic hernias are usually posttraumatic in occurrence. In patients who have blunt trauma and associated diaphragmatic hernia, the diagnosis may be missed or delayed, often leading to poor treatment outcomes. We present a rare occurrence of tension viscerothorax due to missed traumatic diaphragmatic rupture in a 25-year-old woman whose condition was complicated by gangrene and perforation of the fundus as well as questionable viability of the anterior wall of the body of the stomach. The patient had a successful emergency transabdominal suture plication of the diaphragm and gastroplasty and has remained symptomless 3 months postoperatively.

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

2020 ◽  
Vol 48 (6) ◽  
pp. 030006052093086
Author(s):  
Jian-Chun Xiao ◽  
Li-Yuan Ma ◽  
Bing-Lu Li
Keyword(s):  
Penetrating Trauma ◽  
Diaphragmatic Rupture ◽  
Uneventful Recovery ◽  
Trauma Symptoms ◽  
Traumatic Diaphragmatic Rupture ◽  
Left Pleural Effusion ◽  
Threatening Condition ◽  
Diaphragmatic Repair ◽  
Life Threatening ◽  
High Index Of Suspicion

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.

scholarly journals Laparoscopic Treatment of a Rare Right Diaphragmatic Rupture with Small Bowel Herniation after Blunt Thoracic Trauma

2010 ◽  
Vol 2010 ◽  
pp. 1-2 ◽  
Author(s):  
H. Hoffmann ◽  
D. Oertli ◽  
O. Heizmann
Keyword(s):  
Small Bowel ◽  
Laparoscopic Approach ◽  
Diaphragmatic Rupture ◽  
Laparoscopic Treatment ◽  
Diaphragm Rupture ◽  
Traumatic Diaphragmatic Rupture ◽  
Threatening Condition ◽  
Life Threatening ◽  
The Right ◽  
Delay Of Diagnosis

Blunt traumatic diaphragmatic rupture (BTDR) is a life-threatening condition with an incidence from 0,8%–1,6% in blunt trauma, mostly located on the left side. The main prognostic factors are severe side injuries and the delay of diagnosis. We present a rare case of a 68-year-old female, with an isolated right diaphragm rupture. The diagnosis was done with a delay of 4 days by thoracic radiographs, which showed a herniation of small bowel into the right thoracic cavity. A reposition of the small bowel and a closure of the diaphragmatic defect by running suture were carried out laparoscopicly. Although large prospective studies concerning the outcome of laparoscopic approach to right BTDR are still missing, we could show, that laparoscopy can be performed safely in right traumatic diaphragm rupture.

scholarly journals Delayedright-Sided Diaphragmatic Rupture after Blunt Chest Trauma: A Rarity

2020 ◽  
Author(s):  
Njem Josiah Miner ◽  
Nehemiah Joshua Dung ◽  
Ngeh Audu Mangai ◽  
Ugwu Benjamin
Keyword(s):  
Differential Diagnosis ◽  
Blunt Trauma ◽  
Blunt Chest Trauma ◽  
Chest Trauma ◽  
Open Repair ◽  
Diaphragmatic Rupture ◽  
Complete Relief ◽  
Traumatic Injuries ◽  
Missed Diagnosis ◽  
The Right

Abstract Traumatic injuries of the diaphragm are relatively uncommon, as such are frequently missed, especially when it occurs following blunt trauma and on the right side. These injuries often occurred in the setting of polytrauma, as such other obvious injuries tend to mask the diaphragmatic injuries thus resulting in delayed or missed diagnosis. We report the case of a 45 year old man with delayed right-sided diaphragmatic rupture following blunt trauma, who had trans-thoracic open repair with complete relief of symptoms. Although right diaphragmatic rupture is uncommon because of the cushioning effect of the liver, it should be included in the differential diagnosis of persistent right sided chest pain in a patient that has sustained previous chest trauma, no matter how remote the history might be.

Radiologic Diagnosis in Traumatic Rupture of the Right Diaphragm

1988 ◽  
Vol 29 (6) ◽  
pp. 653-655 ◽  
Author(s):  
P. E. Nilsson ◽  
P. Aspelin ◽  
O. Ekberg ◽  
J. Senyk
Keyword(s):  
Computed Tomography ◽  
Blunt Trauma ◽  
No Value ◽  
Diaphragmatic Rupture ◽  
Traumatic Rupture ◽  
Radiologic Diagnosis ◽  
Sonographic Examination ◽  
The Right ◽  
Ruptured Diaphragm

A case of right-sided diaphragmatic rupture due to blunt trauma is reported. The diagnosis was confirmed by sonography and diagnostic pneumoperitoneum. Ultrasonography was of great value by showing a discontinuous, ‘flapping’ ruptured diaphragm. Computed tomography was of no value. It was concluded that when right-sided diaphragmatic rupture is suggested sonographic examination should be performed. If the sonographic examination is non-diagnostic, a pneumoperitoneum should follow.

scholarly journals Diaphragmatic Rupture With Left Colon and Spleen Herniation and Small Intestine Injury After Blunt Trauma

2021 ◽  
Author(s):  
Jafar Malmir ◽  
Amin Talebi ◽  
Mahdi Bodagh ◽  
Fatemeh Malasadi
Keyword(s):  
Small Intestine ◽  
Blunt Trauma ◽  
Diaphragmatic Rupture ◽  
Intestinal Injury ◽  
Greater Omentum ◽  
Rare Type ◽  
Traumatic Diaphragmatic Rupture ◽  
Abdominal Organs ◽  
Left Diaphragm ◽  
Daunting Task

Traumatic Diaphragmatic Rupture (TDR) is a rare type of trauma. Small intestine injuries are the third most common type of injury resulting from blunt trauma to abdominal organs. The immediate diagnosis of TDR and bowel injuries is a daunting task. We reported a 53-year-old male patient who was transferred to the hospital by EMS because of a car accident. The chest X-ray showed the left diaphragm elevation. Also, a computed tomography scan revealed that the greater omentum, a portion of the colon, spleen, and stomach were transposed in the hemithorax through a diaphragm rupture. The patient underwent laparotomy and the incidental findings in laparotomy showed bowel injuries. This case was a common cause of traumatic left-sided diaphragmatic rupture and intestinal injury. The suspicion of diaphragmatic rupture and intestinal injury in a patient with multiple traumas contributes to early diagnosis. Surgical repair remains the only treatment for diaphragmatic rupture. The severe injury in a part of the intestine may result in the resection of that part.

scholarly journals Delayed Traumatic Diaphragmatic Hernia With Bacterial Pleuritis

2016 ◽  
Vol 101 (5-6) ◽  
pp. 270-274
Author(s):  
Yu Ohkura ◽  
Shusuke Haruta ◽  
Yusuke Maeda ◽  
Hisashi Shinohara ◽  
Masaki Ueno ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Diaphragmatic Hernia ◽  
Diaphragmatic Rupture ◽  
Traumatic Diaphragmatic Hernia ◽  
Hernia Mesh ◽  
Reactive Protein ◽  
Traumatic Diaphragmatic Rupture ◽  
Absorbable Sutures ◽  
Abdominal Blunt Trauma ◽  
Traumatic Pneumothorax

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.

Diaphragmatic Injuries: What Has Changed over a 20-Year Period?

2010 ◽  
Vol 76 (5) ◽  
pp. 512-516 ◽  
Author(s):  
Peter P. Lopez ◽  
Jorge Arango ◽  
Theresa M. Gallup ◽  
Stephen M. Cohn ◽  
John Myers ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Chart Review ◽  
Injury Severity ◽  
Penetrating Trauma ◽  
Retrospective Chart Review ◽  
Diaphragmatic Injury ◽  
Associated Injuries ◽  
Severity Scores ◽  
Diaphragm Injuries ◽  
Overall Mortality

Traumatic diaphragmatic injuries are uncommon events but are associated with a high mortality. We hypothesize that injury pattern has changed over time with increasing prevalence of blunt injuries. A retrospective chart review was performed of 124 patients who sustained traumatic diaphragmatic injuries over the 20-year period between January 1,1986 and December 31, 2005. Penetrating trauma accounted for 65 per cent (80/124) of all diaphragm injuries, and blunt trauma for 35 per cent (44/124). Mean Injury Severity Scores of 19 ± 9 and 34 ± 13 were observed for the penetrating and blunt trauma groups, respectively ( P = 0.001). Blunt traumatic diaphragm injuries increased from 13 per cent in the first 10-year period to 66 per cent in the second 10-year period ( P = 0.001). The overall mortality was 9 per cent (11/124) with 10 deaths resulting from blunt trauma and one resulting from penetrating trauma ( P < 0.001). The mortality rate increased from 3 to 17 per cent over the two decades ( P = 0.007). Our data suggests that over the last 20 years, the increase in mortality associated with traumatic diaphragmatic injury is primarily related to an increase in the proportion of patients with blunt trauma as a cause of their diaphragmatic injury and associated injuries.

scholarly journals The Role of CT Scan in Recognizing Blunt Diaphragmatic Rupture

2012 ◽  
Vol 1 (1) ◽  
pp. 24-26
Author(s):  
Edward Passos ◽  
Bartolomeu Nascimento ◽  
Fernando Spencer Netto ◽  
Homer Tien
Keyword(s):  
Ct Scan ◽  
Blunt Trauma ◽  
New Technologies ◽  
Motor Vehicle ◽  
Diaphragmatic Rupture ◽  
High Morbidity ◽  
Trauma Patients ◽  
Ct Scanner ◽  
Traumatic Diaphragmatic Rupture

ABSTRACT Background Blunt traumatic diaphragmatic rupture (BTDR) occurs when signicant deceleration mechanism and energy are applied to the torso, and it is associated with signicant injuries and high morbidity and mortality. Although it has limitations, CT scan is the diagnostic of choice for BTDR. This study is a retrospective analyse of our experience in diagnosing BTDR using the 64-slice CT scanner. Sensitivity and specicity of this exam were assessed. Methods We reviewed reports from 2006 to 2009 of all CT scans of the abdomen that were done in the rst 24 hours of hospitalization of blunt trauma patients. We compared CT ndings to surgery reports. Results Our cohort consisted of 2670 patients; 69% were male. We found 28 cases of BTDR, most of them on the patient s left side (54%). Eleven percent of cases were bilateral. BTDR was often caused by motor vehicle collisions. We found sensitivity of 86%, specicity of 99%. Conclusion CT scan is reliable tool in blunt trauma patients. As new technologies arise, its sensibility and specicity also increases. How to cite this article Passos E, Nascimento B, Netto FS, Tien H, Rizoli S. The Role of CT Scan in Recognizing Blunt Diaphragmatic Rupture. Panam J Trauma Critical Care Emerg Surg 2012;1(1):24-26.

Sign in / Sign up

Export Citation Format

Share Document