Acute Large Bowel Obstruction Following Late Sequelae of Traumatic Diaphragmatic Hernia

A 33 years old patient was admitted in a Military Hospital with the features of acute large gut obstruction. Exploratory laparotomy was done and peroperatively the obstruction was seen in the transverse colon and obstruction seemed to be carcinoma of transverse colon with involvement of left hemidiaphragm which was not negotiable. Transverse loop colostomy with decompression of bowel was done. Subsequently the patient was transferred to tertiary level hospital in Dhaka. In the tertiary hospital, the patient developed left sided massive pleural effusion. With relevant investigation the condition was diagnosed as left sided diaphragmatic hernia. Thoracotomy was done and herniorrhophy was performed after reduction of the content. Post-operative management was stormy and eventful but the condition improved gradually and the patient was discharged in proper time. The patient had history of chest trauma due to RTA he met 4 years back and he received hospital indoor management for 3½ months. The patient was asymptomatic and leading normal active military life before 2nd time admission for acute intestinal obstruction. The patient had past history of trauma to left chest wall 4 years back, presented with acute large gut obstruction and there was diagnostic dilemma. There were management difficulties and post operative events were stormy. The aim of this reporting is to highlight all of these. Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 119-120

Download Full-text

A case of colon necrosis resulting from a delayed traumatic diaphragmatic hernia

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa101 ◽

2020 ◽

Vol 2020 (6) ◽

Author(s):

Héloïse Tessely ◽

Stéphane Journé ◽

Alexis Therasse ◽

Didier Hossey ◽

Jean Lemaitre

Keyword(s):

Abdominal Pain ◽

Intestinal Obstruction ◽

Diaphragmatic Hernia ◽

Emergency Surgery ◽

Past History ◽

Traumatic Diaphragmatic Hernia ◽

Abdominal Symptoms ◽

History Of ◽

Diaphragmatic Hernias

Abstract We present the case of a 71 years old woman who came at the emergency room for abdominal pain and symptoms of occlusion. The scanner demonstrated a colonic occlusion resulting from an incarceration, diagnosed as a hernia of Bochdalek. But two old rib fractures and a past history of a fall directed us to the diagnostic of delayed diaphragmatic rupture. The patient was operated in emergency and post-operative follow-up was simple. Traumatic diaphragmatic hernias are rarely diagnosed directly after trauma. Complications such as pneumonia, occlusion, enteric ischemia, visceral perforation and twisting of splenic hilium can occur many years after the trauma. This is why, for patients with intestinal obstruction or association of pulmonary abdominal symptoms and history of thoraco-abdominal injury, the diagnostic of diaphragmatic hernia should be considered. When patients present complications, there is a higher rate of morbidity and mortality (31%) reason why, emergency surgery is mandatory.

Download Full-text

A case of Young Stroke due to Moyamoya Disease

Journal of Armed Forces Medical College Bangladesh ◽

10.3329/jafmc.v15i1.48659 ◽

2020 ◽

Vol 15 (1) ◽

pp. 110-113

Author(s):

Md Abdur Razzak ◽

Ghulam Kawnayn ◽

Fateha Naznin ◽

Quazi Audry Arafat Rahman

Keyword(s):

Moyamoya Disease ◽

Past History ◽

Cerebral Arteries ◽

Armed Forces ◽

Cerebral Angiogram ◽

Medical College ◽

Middle Cerebral Arteries ◽

History Of ◽

Collateral Vessels ◽

The Right

Moyamoya disease is a disease in which certain arteries in the brain are constricted. Blood flow is blocked by the constriction, and also by blood clots (thrombosis). A collateral circulation develops around the blocked vessels to compensate for the blockage, but the collateral vessels are small, weak, and prone to bleeding, aneurysm and thrombosis which may result in TIA, recurrent ischemic or hemorrhagic stroke or seizure. The disease may manifest in pediatric age or young adults. In May 2019 we have diagnosed a young lady with Moyamoya disease who presented with right sided hemiplegia, motor aphasia and dysphagia. She was labeled as hypertensive 6 months prior to this event and used to take anti-hypertensive irregularly and gave past history of occasional headache. Her CT scan and MRI of brain revealed left sided ischemic infarct involving frontotemporoparietal region and cerebral angiogram revealed narrowing of left MCA and non-visualization of distal part. There is extensive fine collaterals (Moyamoya vessels) giving the appearance of puffed smoke. The right ACA and MCA were also narrowed with appearance of early collateral vessels. She was treated with aspirin, PPI, NG feeding, antihypertensive medication, physiotherapy, rehabilitation therapy and other supportive care. His condition gradually improved and discharged on 2.7.19. He was referred to Department of Neurosurgery for cerebral revascularization by STA-MCA (superficial temporal and middle cerebral arteries) bypass surgery after stabilization and MR perfusion study. Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 110-113

Download Full-text

Right sided traumatic diaphragmatic hernia repair with intrathoracic herniation of liver, stomach and transverse colon

Egyptian Journal of Chest Diseases and Tuberculosis ◽

10.1016/j.ejcdt.2015.03.019 ◽

2015 ◽

Vol 64 (3) ◽

pp. 729-731

Author(s):

Surendra Patel ◽

Dheeraj Sharma ◽

Rajendra Mohan Mathur ◽

Anula Sisodia

Keyword(s):

Hernia Repair ◽

Diaphragmatic Hernia ◽

Transverse Colon ◽

Traumatic Diaphragmatic Hernia ◽

Diaphragmatic Hernia Repair

Download Full-text

Traumatic diaphragmatic hernia complicating pregnancy

East and Central African Journal of Surgery ◽

10.4314/ecajs.v23i2.7 ◽

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

Download Full-text

A tale of traumatic diaphragmatic hernia

International Surgery Journal ◽

10.18203/2349-2902.isj20205918 ◽

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.

Download Full-text

Intrathoracic Acute Cholecystitis

European Journal of Case Reports in Internal Medicine ◽

10.12890/2020_001764 ◽

2020 ◽

Author(s):

Giovana Ennis ◽

Gabriela Venade ◽

Joana Silva Marques ◽

Paulo Batista ◽

Ana Abreu Nunes ◽

...

Keyword(s):

Acute Cholecystitis ◽

Diaphragmatic Hernia ◽

Traumatic Injury ◽

Traumatic Diaphragmatic Hernia ◽

Reactive Protein ◽

Dark Urine ◽

History Of ◽

Slight Elevation ◽

Loss Of Appetite ◽

Work Up

The authors present the case of a 51-year-old woman with no history of surgical or traumatic injury or accident, who presented with right hypochondrium and epigastric discomfort, malaise, nausea, loss of appetite and episodes of dark urine and greenish stools. Initial laboratory work-up revealed elevated inflammatory markers including leucocytosis with left shift and C-reactive protein, and a slight elevation of gamma-glutamyltransferase and alkaline phosphatase, with no other significant alterations. Computed tomography (CT) showed intrathoracic acute cholecystitis with a large diaphragmatic hernia. A literature search revealed only one other case of acute cholecystitis complicated by intrathoracic gallbladder due to a non-traumatic diaphragmatic hernia. Symptoms are uncharacteristic and the absence of pain or fever, explained by the altered location of the gallbladder, makes the diagnosis a challenge.

Download Full-text

Infantile Colic: Incidence and Effectiveness of Conventional Therapy

Journal of Armed Forces Medical College Bangladesh ◽

10.3329/jafmc.v12i1.39975 ◽

2016 ◽

Vol 12 (1) ◽

pp. 83-87

Author(s):

Syeda Zeenat Laila ◽

Anjuman Ara Beauty ◽

Md Mahboob Hasan ◽

Md Mizanur Rahman Khan

Keyword(s):

Conventional Therapy ◽

Armed Forces ◽

Cross Sectional Study ◽

Military Hospital ◽

Infantile Colic ◽

Cross Sectional ◽

Medical College ◽

History Of ◽

Limiting Condition ◽

Neonates And Infants

Introduction: Infantile colic is defined as excessive crying for more than three hours a day at least three days a week for one week or more in an otherwise healthy baby. It is most frequently observed in neonates and infants aged two weeks to four months. Objective: To assess the incidence of infantile colic and effectiveness of conventional therapy. Materials and Methods: This was a prospective cross sectional study of 50 cases carried out in Paediatric out patient department in Combined Military Hospital (CMH) Ghatail during the period of September 2010 to August 2012. Data recorded including demographics, clinical presentations, management and the outcome of therapy. Results: Out of the total 50 patients, 24(48%) were male and 26(52%) were female. Male:Female=1:1.08. Babies delivered vaginally suffered more 32(64%), full term delevered babies 33 (66%) suffered more than that of gestational age group <37 wk. Non-exclusive Breastfed (Formula fed, combination of breastfed and formula fed) babies having more incidence of colic 31(62%). Maximum patients 26(52%) had history of cry 4-5 hours per day. Motion (Rocking, bouncing, walking etc) 18(36%), change of diet 14(28%) were considerable satisfactory treatments. Conclusion: Since it is a self limiting condition, conventional therapy should be tried for instant relief. Journal of Armed Forces Medical College Bangladesh Vol.12(1) 2016: 83-87

Download Full-text

Lessons Learned from Psychological Autopsies in Armed Forces

Indian Journal of Psychological Medicine ◽

10.1177/0253717620950254 ◽

2020 ◽

pp. 025371762095025

Author(s):

Alok Sinha ◽

Sriniwas Gupta ◽

Madhubrata Ray ◽

Sanjay Kumar ◽

Anindya Kumar Gupta

Keyword(s):

Mental Illness ◽

Behavioral Change ◽

Past History ◽

Armed Forces ◽

Lessons Learned ◽

Psychological Autopsy ◽

Prophylactic Measures ◽

Semistructured Interviews ◽

Strategic Location ◽

History Of

Background: Suicide in armed forces is a matter of concern despite adequate prophylactic measures that have been adopted to reduce it. Military psychiatrists routinely conduct psychological autopsies. It may reveal various biopsychosocial factors leading to suicide and may be helpful in suicide prevention too. A few studies have been done in Indian Armed Forces but all of them involve cases of attempted suicide. Our study is different as it uses the methodology of psychological autopsy to find out various psychosocial factors of suicide in armed forces. Methods: The present study was carried out in a large service hospital and included all suicide cases occurring in a particular strategic location from February 2014 to July 2017. A total of 16 suicide cases were investigated, and information was collected through visiting the scene, detailed semistructured interviews, the perusal of mobile call records, social website activities, notes in a social diary, bank statements, service record, and health records. Results: The majority (nine of sixteen) of suicide victims were less than 30 years of age. The most common method of suicide (ten of sixteen) was use of firearms. Family history of mental illness/suicide was seen in three of them. Three had a past history of mental illness. Two were abusing substance in the recent past. Behavioral change was noticed in three, and suicide notes were available in three cases. Five had expressed their intent to die. Conclusions: Strain of serving in frontiers is not a common stressor associated with suicide as commonly perceived.

Download Full-text

A Diagnostic Dilemma of Recurrent Disseminated Peritoneal Leiomyomatosis with Hypertrophied Omental Vessels: Imaging and Embolization of Omental Branches with Positive Outcome

Case Reports in Obstetrics and Gynecology ◽

10.1155/2017/8427240 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Jitendra Parmar ◽

Chander Mohan ◽

Deepak Hans ◽

Maulik Vora

Keyword(s):

Internal Mammary Artery ◽

Anterior Abdominal Wall ◽

Past History ◽

Positive Outcome ◽

Diagnostic Dilemma ◽

Internal Mammary ◽

History Of ◽

Disseminated Peritoneal Leiomyomatosis ◽

One Year ◽

The Right

We present a case report of recurrent disseminated peritoneal leiomyomatosis in a 30-year-old female with a past history of laparoscopic myomectomy by a technique of morcellation for a large fibroid in 2014. After one year she presented in 2015 with a well-defined oval shaped fibroid along the anterior abdominal wall, which was supplied by the 10th intercostal artery and a branch of right internal mammary artery. She was again presented after 1 year in 2016 with a large pelvic-abdominal fibroid with blood supply from the omental artery, a branch from the right gastroepiploic artery, and sigmoid branches of inferior mesenteric artery.

Download Full-text