scholarly journals Traumatic Diaphragmatic Hernia

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Nurashidah Musa ◽  
Ruben Gregory Xavier
Keyword(s):  
Respiratory Distress ◽  
Diaphragmatic Hernia ◽  
Left Lung ◽  
Penetrating Trauma ◽  
Exploratory Laparotomy ◽  
Left Lobe ◽  
Falciform Ligament ◽  
Left Hemithorax ◽  
Traumatic Diaphragmatic Hernia ◽  
Abdominal Symptoms

Traumatic diaphragmatic hernia (TDH) is uncommon and it can be a result from both blunt and penetrating trauma. About to 1% to 7% of patients with blunt trauma sustained TDH. Left sided traumatic diaphragmatic hernia are much common compared to right side.TDH can present acutely or delayed with signs of respiratory distress of intestinal obstruction. The diagnosis was made with the aid of chest radiograph and computed topography (CT) abdomen. A coiled nasogastric tube within the hemithorax is a pathognomonic for TDH. We are presenting a case of high impact injury resulting in a TDH in a 19-year-old, malay male with unsure mechanism injury. He presented with generalised abdominal pain and in respiratory distress with a clinical evidence of abdominal tenderness and type 1 respiratory failure. Subsequently, he underwent exploratory laparotomy and repair of left diaphragmatic hernia. Intraoperatively, noted large linear tear of left hemidiaphragm posterolaterally extending medially until the insertion of falciform ligament. Stomach, left lobe of liver, spleen and splenic flexure of colon were herniated into the left hemithorax. The left diaphragmatic tear was repaired in 2 layers using prolene. A left subdiaphgramatic drain and a chest tube were inserted. Post operatively, the patient was nursed in ICU and recovered well. Repeated chest x -ray showed left lung was fully expanded. With aggressive chest physiotherapy and incentive spirometry, he recovered well and was discharged home. In trauma, there should be a high index of suspicion in patients with both respiratory and abdominal symptoms. Conclusion: Prompt recognition and early definitive management can improve patient outcomes.

scholarly journals Comorbidity between Klinefelter syndrome and diaphragmatic hernia. A case report

2014 ◽  
Vol 132 (5) ◽  
pp. 311-313
Author(s):  
Carolina Melendez Valdez ◽  
Stephan Philip Leonhardt Altmayer ◽  
Adyr Eduardo Virmond Faria ◽  
Aline Weiss ◽  
Jorge Alberto Bianchi Telles ◽  
...  
Keyword(s):  
Diaphragmatic Hernia ◽  
Ultrasound Examination ◽  
Klinefelter Syndrome ◽  
Age Groups ◽  
Left Lung ◽  
Left Lobe ◽  
Imaging Studies ◽  
Left Hemithorax ◽  
Prenatal Imaging ◽  
The Right

CONTEXT: Intrathoracic cystic lesions have been diagnosed in a wide variety of age groups, and the increasing use of prenatal imaging studies has allowed detection of these defects even in utero.CASE REPORT: A 17-year-old pregnant woman in her second gestation, at 23 weeks of pregnancy, presented an ultrasound with evidence of a cystic anechoic image in the fet al left hemithorax. A morphological ultrasound examination performed at the hospital found that this cystic image measured 3.7 cm x 2.1 cm x 1.6 cm. Polyhydramnios was also present. At this time, the hypothesis of cystic adenomatoid malformation was raised. Fet al echocardiography showed only a dextroposed heart. Fet al magnetic resonance imaging produced an image compatible with a left diaphragmatic hernia containing the stomach and at least the first and second portions of the duodenum, left lobe of the liver, spleen, small intestine segments and portions of the colon. The stomach was greatly distended and the heart was shifted to the right. There was severe volume reduction of the left lung. Fet al karyotyping showed the chromosomal constitution of 47,XXY, compatible with Klinefelter syndrome. In our review of the literature, we found only one case of association between Klinefelter syndrome and diaphragmatic hernia.CONCLUSIONS: We believe that the association observed in this case was merely coincidental, since both conditions are relatively common. The chance of both events occurring simultaneously is estimated to be 1 in 1.5 million births.

scholarly journals A tale of traumatic diaphragmatic hernia

2020 ◽  
Vol 8 (1) ◽  
pp. 420
Author(s):  
Indrajit Anandakannan ◽  
Shanthi Ponnandai Swaminathan ◽  
Vikas Kawarat ◽  
Rajeshwari Mani ◽  
Arul Kumar Chinnappan ◽  
...  
Keyword(s):  
Diaphragmatic Hernia ◽  
Bone Fracture ◽  
Transverse Colon ◽  
Left Lung ◽  
Left Shoulder ◽  
Bowel Sound ◽  
Left Hemithorax ◽  
Scapula Fracture ◽  
X Ray ◽  
Traumatic Diaphragmatic Hernia

A traumatic diaphragmatic hernia is uncommon which accounts for 0.8 to 1.6%. In Blunt or penetrating abdominal injury, the patient presents as early or delayed respiratory distress or intestinal obstruction. We present the 55-year old female with a road traffic accident (pedestrian versus two-wheeler) with left-sided chest pain and breathlessness, left shoulder and leg pain referred to our institute. On examination, left hemithorax decreased breath sound and bowel sound was present, chest compression test positive, normal bowel sound in the abdomen, restricted left shoulder movement and abnormal mobility of shaft of left tibia and fibula. A plain X-ray of the chest and abdomen showed bowel shadow in the left hemithorax up to the apex. Computed tomography (CT) of thorax and abdomen shows herniation of stomach, transverse colon, omentum in the left hemithorax with collapsed left lung. A plain X-ray of the left shoulder shows neck of scapula fracture, left leg both bone fracture. Suggesting traumatic diaphragmatic hernia took emergency surgery, laparotomy was made intact stomach, transverse colon, omentum reduced with no injuries, radially placed diaphragmatic rent of size 10 cm × 5.5 cm through which left lung inferior lobe visualized, medial edge of rent close to the pericardial pad of fat. Other solid organs normal, left thoracic drain was fashioned. Rent was closed with interrupted polypropylene with intraabdominal drain. Left leg both bone fracture was done with tibial nailing and left neck of scapula fracture managed conservatively. Abdominal approach is sufficient rather than a thoracoabdominal approach given associated intraabdominal injuries, nowadays minimal access approaches preferred.

scholarly journals P034 STRANGULATED DIAPHRAGMATIC HERNIA: TEN CASES REPORTS

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Mehmet Gunay ◽  
gorkem uzunyolcu ◽  
yalın iscan ◽  
kaan gok ◽  
hakan yanar ◽  
...  
Keyword(s):  
Total Gastrectomy ◽  
Diaphragmatic Hernia ◽  
Emergency Surgery ◽  
Penetrating Trauma ◽  
Abdominal Symptoms ◽  
Threatening Condition ◽  
Segmental Bowel Resection ◽  
Life Threatening ◽  
Surgery Department ◽  
Laparoscopic Techniques

Abstract Aim A diaphragmatic hernia (DH) is a protrusion of abdominal contents into the thoracic cavity as a result of a defect within diaphragm. It is most common as a congenital phenomenon; however, there have also been cases where it can be acquired. DH can be life-threatening, resulting in incarceration and strangulation. Material and Methods From June 2009 to April 2021, ten cases of strangulated diaphragmatic hernia were admitted to our Emergency Surgery Department of General Surgery with respiratory and abdominal symptoms. Patients' characteristics, operation details, and postoperative complications were retrospectively analyzed. Results There were 5 (50%) men and 5 (50%) women with a mean age of 66 years (range, 20–85 years). . Emergency surgery was performed by laparoscopic in 4(40%) patients and open in 6(60%) patients. Two patients had a history of penetrating trauma to the left thoracoabdominal region. Segmental bowel resection was performed in 3 patients and total gastrectomy in 1 patient. Reconstruction was not performed in the patient who underwent total gastrectomy due to ischemia and perforation. In the postoperative period, wound infection was observed in 2 patients. Anastomotic leakage was observed in 1 patient and treated with end enterostomy. Empyema was observed in one patient after discharge, the empyema was evacuated and thoracoscopic decortication was performed .The patient who underwent total gastrectomy died due to septic shock and comorbid diseases. Conclusions Strangulated diaphragmatic hernia is a life-threatening condition and requires emergency surgery. Laparoscopic techniques can also be used in treatment.

scholarly journals Traumatic diaphragmatic hernia complicating pregnancy

2018 ◽  
Vol 23 (2) ◽  
pp. 83-85
Author(s):  
Brightson N. Mutseyekwa ◽  
Mordecai Sachikonye ◽  
Lameck Chiwaka ◽  
Netsai C. Changata
Keyword(s):  
Intestinal Obstruction ◽  
Diaphragmatic Hernia ◽  
Large Bowel ◽  
Transverse Colon ◽  
Signs And Symptoms ◽  
Exploratory Laparotomy ◽  
Large Bowel Obstruction ◽  
Traumatic Diaphragmatic Hernia ◽  
Foetal Mortality ◽  
In Pregnancy

Intestinal obstruction in pregnancy is rare but has a high maternal and foetal mortality. We present a case of 32-year-old patient who presented in her 2nd trimester of pregnancy with signs and symptoms of large bowel obstruction. An exploratory laparotomy revealed that the transverse colon had herniated through a diaphragmatic tear as the cause of the intestinal obstruction. The delays in presentation and diagnostic dilemmas associated with intestinal obstruction in pregnancy are manifested in this case. Keywords: intestinal obstruction; pregnancy; diaphragmatic hernia 

scholarly journals Heart hypoplasia in an animal model of congenital diaphragmatic hernia

2001 ◽  
Vol 56 (6) ◽  
pp. 173-178 ◽  
Author(s):  
Uenis Tannuri
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Experimental Model ◽  
Diaphragmatic Hernia ◽  
Interventricular Septum ◽  
Left Lung ◽  
Therapeutic Strategies ◽  
Left Lobe ◽  
The Body ◽  
Lung Hypoplasia ◽  
The Right

PURPOSE: In previous papers, we described a new experimental model of congenital diaphragmatic hernia in rabbits, and we also reported noninvasive therapeutic strategies for prevention of the functional and structural immaturity of the lungs associated with this defect. In addition to lung hypoplasia, pulmonary hypertension, biochemical, and structural immaturity of the lungs, the hemodynamics of infants and animals with congenital diaphragmatic hernia are markedly altered. Hence, cardiac hypoplasia has been implicated as a possible cause of death in patients with congenital diaphragmatic hernia, and it is hypothesized to be a probable consequence of fetal mediastinal compression by the herniated viscera. Cardiac hypoplasia has also been reported in lamb and rat models of congenital diaphragmatic hernia. The purpose of the present experiment was to verify the occurrence of heart hypoplasia in our new model of surgically produced congenital diaphragmatic hernia in fetal rabbits. METHODS: Twelve pregnant New Zealand rabbits underwent surgery on gestational day 24 or 25 (normal full gestational time - 31 to 32 days) to create left-sided diaphragmatic hernias in 1 or 2 fetuses per each doe. On gestational day 30, all does again underwent surgery, and the delivered fetuses were weighed and divided into 2 groups: control (non-surgically treated fetuses) (n = 12) and congenital diaphragmatic hernia (n = 9). The hearts were collected, weighed, and submitted for histologic and histomorphometric studies. RESULTS: During necropsy, it was noted that in all congenital diaphragmatic hernia fetuses, the left lobe of the liver herniated throughout the surgically created defect and occupied the left side of the thorax, with the deviation of the heart to the right side, compressing the left lung; consequently, this lung was smaller than the right one. The body weights of the animals were not altered by congenital diaphragmatic hernia, but heart weights were decreased in comparison to control fetuses. The histomorphometric analysis demonstrated that congenital diaphragmatic hernia promoted a significant decrease in the ventricular wall thickness and an increase in the interventricular septum thickness. CONCLUSION: Heart hypoplasia occurs in a rabbit experimental model of congenital diaphragmatic hernia. This model may be utilized for investigations in therapeutic strategies that aim towards the prevention or the treatment of heart hypoplasia caused by congenital diaphragmatic hernia.

scholarly journals Surgical Management of Traumatic Diaphragmatic Hernia: a Single Institutional Experience of More Than Two Decades.

2020 ◽  
Author(s):  
Xicheng Deng ◽  
Zuosheng Deng ◽  
Erjia Huang
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Surgical Management ◽  
Diaphragmatic Hernia ◽  
Multiple Logistic Regression Analysis ◽  
Univariate Analysis ◽  
Penetrating Trauma ◽  
Traumatic Diaphragmatic Hernia ◽  
Risk Of Death ◽  
Severity Scores

Abstract Background: We present here our experience with surgical management of traumatic diaphragmatic hernia, trying to find out the era impact of different periods on the outcome and risk factors of mortality. Methods: A series of 63 patients with traumatic diaphragmatic hernia were referred to us and operated on during March, 1990-August, 2017. The patient records were reviewed and statistically analyzed to demonstrate injury characteristics and to find out optimal treatment strategy, risk factors of death as well as the difference between two periods (1990-2005, 2005-2017) divided by introduction of computed tomography at our institution.Results: The overall mean age was 31.2±16.3 years old with a female to male ratio of 11/52. The mechanism was penetrating trauma in 19 cases (30.2%), and blunt trauma in 44 cases (69.9%). Two thirds of the patients in the latter period yet none in the former period underwent computed tomography. Ten patients (15.9%), of which 8 in the former and the other 2 in the latter period (p=.042), had late diagnoses. The most commonly used incision was a thoracotomy (n=43, 89.6%). There was no statistical difference in etiology or mortality between the two periods. Univariate analysis showed survivors were younger, and had lesser injury severity scores (ISS) and lower American Association for the Surgery of Trauma (AAST) grade than nonsurvivors. By multiple logistic regression analysis, increased age (odds ratio, 1.275; p=.013) and greater ISS (OR, 1.174; p=.028) were risk factors of death in all patients.Conclusions: High definition computed tomography has significantly improved the preoperative diagnosis rate. The transthoracic approach could be used in selected cases with traumatic diaphragmatic hernia with good outcomes. Patients with greater ISS and advanced age are at higher risk of death.

scholarly journals Prenatal Diagnosis and Postnatal Findings of Bronchogenic Cyst

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Livia Teresa Moreira Rios ◽  
Edward Araujo Júnior ◽  
Luciano Marcondes Machado Nardozza ◽  
Antonio Fernandes Moron ◽  
Marília da Glória Martins
Keyword(s):  
Prenatal Diagnosis ◽  
Respiratory Distress ◽  
Bronchogenic Cyst ◽  
Left Lung ◽  
Tertiary Hospital ◽  
Tracheobronchial Tree ◽  
Normal Lung ◽  
Left Hemithorax ◽  
Left Chest ◽  
Bronchogenic Cysts

Bronchogenic cysts arise from abnormal buds from the primitive esophagus and tracheobronchial tree, which do not extend to the site where alveolar differentiation occurs. Bronchogenic cysts are typically unilocular mucus field lesions arising from posterior membranous wall of the air way. The prenatal diagnosis usually is realized by two-dimensional ultrasound showing the large unilocular cystic image in the chest fetus. The prenatal percutaneous aspiration can reduce the risk of heart compression and permit better respiratory conditions to newborn. We present a case of a primiparous pregnant 23 year-old-woman prenatal ultrasound showed a large unilocular cyst in the left hemithorax with compression of the normal left lung tissue and contralateral mediastinal shift. This cyst was percutaneously aspirated without subsequent reaccumulation of fluid. The newborn did not have respiratory distress and the computed tomography scan confirmed the finding of a fluid-filled cyst in the left chest. The chest X-ray showed the displacement of the heart and the mediastinum from the left to the right. The prenatal diagnosis of bronchogenic cyst is very important to assess the degree of the compression of the normal lung and the mediastinum shift. Furthermore, the prenatal diagnosis permits planning delivery in the tertiary hospital with multidisciplinary team because of the risk of respiratory distress.

scholarly journals Surgical Approach in Management of Posttraumatic Diaphragmatic Hernia: Thoracotomy versus Laparotomy

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Ahmed Shabhay ◽  
Pius Horumpende ◽  
Zarina Shabhay ◽  
Sjef G. Van Baal ◽  
Ester Lazaro ◽  
...  
Keyword(s):  
Diaphragmatic Hernia ◽  
Surgical Approach ◽  
Abdominal Cavity ◽  
Left Lobe ◽  
Delayed Presentation ◽  
Thoracic Cavity ◽  
Visceral Injury ◽  
Traumatic Diaphragmatic Hernia ◽  
Diaphragmatic Repair ◽  
Management Approaches

Breach in diaphragmatic musculature permits abdominal viscera to herniate into the thoracic cavity. Time of presentation and associated injuries determines the surgical approach in management. This case report sets to highlight the challenges in clinical diagnosis, radiological interpretation, and surgical management approaches of posttraumatic diaphragmatic hernia. We report a case of a 43 years old male who was diagnosed with traumatic diaphragmatic hernia 6 months post blunt thoracoabdominal trauma due to motor traffic accident. He was initially diagnosed with haemothorax, drained with an underwater thoracostomy tube, and discharged. He continued to experience on and off chest pain worsening postfeeding, difficulty in breathing and abdominal pain for the next six months until his eventual diaphragmatic hernia diagnosis. He was scheduled for an elective thoracotomy. A left posterolateral thoracic over the 7th intercostal space incision was used. Intraoperatively, the stomach, left lobe of liver, part of transverse colon, small bowel, and omentum had herniated into the thoracic cavity adhering into thoracic viscera and wall. Adhesiolysis was done, and abdominal organs reduced into abdominal cavity. Rent was closed by interrupted Prolene sutures reinforced with a mesh. In patients with delayed presentation of diaphragmatic hernia post blunt thoracoabdominal injury without associated intra-abdominal visceral injury, we recommend the thoracic diaphragmatic repair approach as long-standing herniated bowels might adhere with thoracic cavity walls or viscera. In such cases, adhesiolysis and rent repair is easier through thoracotomy.

scholarly journals Surgical management of traumatic diaphragmatic hernia: a single institutional experience of more than two decades

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xicheng Deng ◽  
Zuosheng Deng ◽  
Erjia Huang
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Surgical Management ◽  
Diaphragmatic Hernia ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Penetrating Trauma ◽  
Traumatic Diaphragmatic Hernia ◽  
Risk Of Death ◽  
Severity Scores

Abstract Background We present here our experience with surgical management of traumatic diaphragmatic hernia, trying to find out the era impact of different periods on the outcome and risk factors of mortality. Methods A series of 63 patients with traumatic diaphragmatic hernia were referred to us and operated on during March, 1990-August, 2017. The patient records were reviewed and statistically analyzed to demonstrate injury characteristics and to find out optimal treatment strategy, risk factors of death as well as the difference between two periods (1990–2005, 2005–2017) divided by introduction of computed tomography at our institution. Results The overall mean age was 31.2 ± 16.3 years old with a female to male ratio of 11/52. The mechanism was penetrating trauma in 19 cases (30.2%), and blunt trauma in 44 cases (69.9%). Two thirds of the patients in the second group (2005–2017) yet none in the first group (1990–2005) underwent computed tomography. Ten patients (15.9%), of which 8 in the first and the other 2 in the second group (p = .042), had late diagnoses. The most commonly used incision was a thoracotomy (n = 43, 89.6%). There was no statistical difference in etiology or mortality between the two periods. Univariate analysis showed survivors were younger, and had lesser injury severity scores (ISS) and lower American Association for the Surgery of Trauma (AAST) grade than non-survivors. By multivariate logistic regression analysis, increased age (odds ratio, 1.275; p = .013) and greater ISS (OR, 1.174; p = .028) were risk factors of death in all patients. Conclusions High-definition computed tomography has significantly improved the preoperative diagnosis rate. The transthoracic approach could be used in selected cases with traumatic diaphragmatic hernia with good outcomes. Patients with greater ISS and advanced ages are at a higher risk of death.

scholarly journals Late Onset Traumatic Diaphragmatic Herniation Leading to Intestinal Obstruction and Pancreatitis: Two Separate Cases

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Tolga Dinc ◽  
Selami Ilgaz Kayilioglu ◽  
Faruk Coskun
Keyword(s):  
Acute Pancreatitis ◽  
Intestinal Obstruction ◽  
Diaphragmatic Hernia ◽  
Chest Trauma ◽  
Late Onset ◽  
Penetrating Trauma ◽  
The Other ◽  
Trauma Patients ◽  
Traumatic Diaphragmatic Hernia ◽  
Diaphragmatic Herniation

Although diaphragmatic injuries caused by blunt or penetrating trauma are rare entities, they are the most commonly misdiagnosed injuries in trauma patients and occur in approximately 3–7% of all abdominal or thoracic traumas. Acute pancreatitis secondary to late presenting diaphragmatic hernia is very rare. Here we present two separate cases: one with acute bowel obstruction and the other with acute pancreatitis secondary to late onset traumatic diaphragmatic hernia (three and twenty-eight years after chest trauma, resp.).

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