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

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.

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

Case Reports in Pulmonology ◽

10.1155/2013/814632 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 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.

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

Journal of medical and pharmaceutical sciences - مجلة العلوم الطبية و الصيدلانية ◽

10.26389/ajsrp.r170621 ◽

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.

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Late-Presenting Left-Sided Morgagni Congenital Diaphragmatic Hernia in a 9-Year-Old Male

ISRN Pulmonology ◽

10.5402/2011/409252 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4

Author(s):

Jennifer M. Kim ◽

Marisa Couluris ◽

Bruce M. Schnapf

Keyword(s):

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Gastrointestinal Symptoms ◽

Lower Lobe ◽

Abdominal Radiograph ◽

Rare Occurrence ◽

Abdominal Ct ◽

Abdominal Ct Scan ◽

Diaphragmatic Hernias ◽

Vague Abdominal Pain

Congenital diaphragmatic hernias are common, primarily occurring through the foramen of Bochdalek. However, in contrast, defects through the foramen of Morgagni are much more rare. When late presentations occur, patients may be asymptomatic or may be critically ill with respiratory and gastrointestinal symptoms. In this paper, we present a 9-year-old male who presented with recurrent, vague abdominal pain, and a previously normal abdominal CT scan. Initial investigation via an abdominal radiograph demonstrated an unexpected left lower lobe abnormality. Further evaluation and management revealed this abnormality to be an unusual left-sided congenital diaphragmatic hernia that appeared through the retrosternal foramen of Morgagni, a rare occurrence.

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

Case Reports in Clinical Practice ◽

10.18502/crcp.v6i3.7122 ◽

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.

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Delayed Traumatic Diaphragmatic Hernia With Bacterial Pleuritis

International Surgery ◽

10.9738/intsurg-d-15-00262.1 ◽

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.

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The Role of CT Scan in Recognizing Blunt Diaphragmatic Rupture

Panamerican Journal of Trauma, Critical Care & Emergency Surgery ◽

10.5005/jp-journals-10030-1006 ◽

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.

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Faecopneumothorax due to missing diaphragmatic hernia: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-020-02606-3 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Resul Nusretoğlu ◽

Yunus Dönder

Keyword(s):

Computed Tomography ◽

Diaphragmatic Hernia ◽

Colon Resection ◽

Emergency Laparotomy ◽

Hernia Sac ◽

Case Presentation ◽

Abdominal Tenderness ◽

History Of ◽

Diaphragmatic Hernias ◽

Tomography Scan

Abstract Background Diaphragmatic hernias may occur as either congenital or acquired. The most important cause of acquired diaphragmatic hernias is trauma, and the trauma can be due to blunt or penetrating injury. Diaphragmatic hernia may rarely be seen after thoracoabdominal trauma. Case presentation A 54-year-old Turkish male patient admitted to the emergency department with abdominal pain and dyspnea ongoing for 2 days. He had general abdominal tenderness in all quadrants. He had a history of a stabbing incident in his left subcostal region 3 months ago without any pathological findings in thoracoabdominal computed tomography scan. New thoracoabdominal computed tomography showed a diaphragmatic hernia and fluid in the hernia sac. Due to respiratory distress and general abdominal tenderness, the decision to perform an emergency laparotomy was made. There was a 6 cm defect in the diaphragm. There were also necrotic fluids and stool in the hernia sac in the thorax colon resection, and an anastomosis was performed. The defect in the diaphragm was sutured. The oral regimen was started, and when it was tolerated, the regimen was gradually increased. The patient was discharged on the postoperative 11th day. Conclusions Acquired diaphragmatic hernia may be asymptomatic or may present with complications leading to sepsis. In this report, acquired diaphragmatic hernia and associated colonic perforation of a patient with a history of stab wounds was presented.

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The Word of God in One’s Hand: Touching and Holding Pendant Koran Manuscripts

Das Mittelalter ◽

10.1515/mial-2020-0041 ◽

2020 ◽

Vol 25 (2) ◽

pp. 338-357

Author(s):

Cornelius Berthold

Keyword(s):

Haptic Feedback ◽

The Body ◽

Word Of God ◽

Rare Occurrence ◽

Recent Scholarship ◽

Solid Objects ◽

Cylindrical Form ◽

The Common ◽

Common Era

AbstractKoran manuscripts that fit comfortably within the palm of one’s hand are known as early as the 10th century CE.For the sake of convenience, all dates will be given in the common era (CE) without further mention, and not in the Islamic or Hijra calendar. Their minute and sometimes barely legible script is clearly not intended for comfortable reading. Instead, recent scholarship suggests that the manuscripts were designed to be worn on the body like pendants or fastened to military flag poles. This is corroborated by some preserved cases for these books which feature lugs to attach a cord or chain, but also their rare occurrence in contemporary textual sources. While pendant Korans in rectangular codex form exist, the majority were produced as codices in the shape of an octagonal prism, and others as scrolls that could be rolled up into a cylindrical form. Both resemble the shapes of similarly dated and pre-Islamic amulets or amulet cases. Building on recent scholarship, I will argue in this article that miniature or pendant Koran manuscripts were produced in similar forms and sizes because of comparable modes of usage, but not necessarily by a deliberate imitation of their amuletic ‘predecessors’. The manuscripts’ main functions did not require them to be read or even opened; some of their cases were in fact riveted shut. Accordingly, the haptic feedback they gave to their owners when they carried or touched them was not one of regular books but one of solid objects (like amulets) or even jewellery, which then reinforced this practice.

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Clinical pattern and predictors of stroke treatment outcome among hospitalised patients who had a stroke at Felege Hiwot comprehensive specialised hospital, northwest Ethiopia: a retrospective cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2020-040238 ◽

2020 ◽

Vol 10 (12) ◽

pp. e040238

Author(s):

Belayneh Kefale ◽

Amien Ewunetei ◽

Mulugeta Molla ◽

Gobezie Temesgen Tegegne ◽

Amsalu Degu

Keyword(s):

Treatment Outcome ◽

Treatment Outcomes ◽

Medical Records ◽

Cross Sectional Study ◽

Northwest Ethiopia ◽

Cross Sectional ◽

Stroke Treatment ◽

Clinical Pattern ◽

Hospitalised Patients ◽

Poor Treatment

ObjectivesThis study aimed to assess the clinical pattern and predictors of stroke treatment outcomes among hospitalised patients in Felege Hiwot comprehensive specialised hospital (FHCSH) in northwest Ethiopia.DesignA retrospective cross-sectional study.SettingThe study was conducted medical ward of FHCSH.ParticipantsThe medical records of 597 adult patients who had a stroke were included in the study. All adult (≥18 years) patients who had a stroke had been admitted to the medical ward of FHSCH during 2015–2019 were included in the study. However, patients with incomplete medical records (ie, incomplete treatment regimen and the status of the patients after treatment) were excluded in the study.ResultsIn the present study, 317 (53.1%) were males, and the mean age of the study participants was 61.08±13.76 years. About two-thirds of patients (392, 65.7%) were diagnosed with ischaemic stroke. Regarding clinical pattern, about 203 (34.0%) of patients complained of right-side body weakness and the major comorbid condition identified was hypertension (216, 64.9%). Overall, 276 (46.2%) of them had poor treatment outcomes, and 101 (16.9%) of them died. Patients who cannot read and write (AOR=42.89, 95% CI 13.23 to 111.28, p<0.001), attend primary school (AOR=22.11, 95% CI 6.98 to 55.99, p<0.001) and secondary school (AOR=4.20, 95% CI 1.42 to 12.51, p<0.001), diagnosed with haemorrhagic stroke (AOR=2.68, 95% CI 1.62 to 4.43, p<0.001) and delayed hospital arrival more than 24 hours (AOR=2.92, 95% CI 1.83 to 4.66, p=0.001) were the independent predictors of poor treatment outcome.ConclusionsApproximately half of the patients who had a stroke had poor treatment outcomes. Ischaemic stroke was the most predominantly diagnosed stroke type. Education status, types of stroke and the median time from onset of symptoms to hospitalisation were the predictors of treatment outcome. Health education should be given to patients regarding clinical symptoms of stroke. In addition, local healthcare providers need to consider the above risk factors while managing stroke.

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Bilateral Diaphragmatic Rupture due to Blunt Trauma—A Rare Injury

Journal of Trauma and Acute Care Surgery ◽

10.1097/00005373-197804000-00013 ◽

1978 ◽

Vol 18 (4) ◽

pp. 280-282 ◽

Cited By ~ 8

Author(s):

LESTER R. BRYANT ◽

FREDERICK G. SCHECHTER ◽

RILEY REES ◽

HAROLD M. ALBERT

Keyword(s):

Blunt Trauma ◽

Diaphragmatic Rupture ◽

Rare Injury

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