Grave thoraco-intestinal complication secondary to an undetected traumatic rupture of the diaphragm: a case report

Beshay, Morris; Krüger, Martin; Singh, Kashika; Borgstedt, Rainer; Benhidjeb, Tahar; Bölke, Edwin; Wähnert, Dirk; Esch, Jan Schulte Am

doi:10.1186/s40001-021-00488-9

Cited by 4 publications

(7 citation statements)

References 19 publications

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“…Complications of undetected diaphragmatic defects with incarcerating bowel are rare but can be serious. A thorough investigation should always be undertaken in cases of blunt abdominal and thoracic trauma to exclude diaphragmatic injury in order to avoid post-traumatic complications [ 25 ]. DP through a standard thoracotomy is still the most commonly performed technique.…”

Section: Discussionmentioning

confidence: 99%

Minimally-Invasive Diaphragmatic Plication in Patients with Unilateral Diaphragmatic Paralysis

Beshay¹,

Abdel-Bary

Kösek

et al. 2023

JCM

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Background: Diaphragm eventration (DE) represents a frequent problem with consecutive major impacts on respiratory function and the quality of life of the patients. The role of diaphragmatic plication (DP) is still underestimated. The aim of the present study is to evaluate the efficacy of minimally-invasive surgical diaphragmatic plication for the management of unilateral diaphragmatic eventration, to the best of our knowledge, this is the largest series reported in the literature using a non-resectional technique. Methods: All patients with unilateral diaphragmatic paralysis admitted for diaphragmatic plication (DP) between January 2008 and December 2022 formed the cohort of this retrospective analysis. DP procedure was done to plicate the diaphragm without resection or replacement with synthetic materials. Patients were divided into two groups: Group I included patients who underwent DP through an open thoracotomy, and Group II included patients who underwent DP through video-assisted thoracoscopic surgery (VATS). Data from all patients were collected prospectively and subsequently analyzed retrospectively. Patients’ characteristics, lung function tests, radiological findings, type of surgical procedures, complications, and postoperative follow-up were compared. The primary outcome measure was the postoperative result (deeper position of the paralyzed diaphragm) and improvement of dyspnea. The secondary outcome was lung function values over a long-term follow-up. Results: The study included a total of 134 patients who underwent diaphragmatic plication during the study period. 94 (71.7%) were males, mean age of 64 (SD ± 14.0). Group I (thoracotomy group) consisted of 46 patients (35 male). Group II (VATS-group) consisted of 88 patients (69 male). The majority of patients demonstrated impaired lung functions (n = 126). The mean length of diaphragmatic displacement was 8 cm (SD ± 113.8 cm). The mean duration of the entire procedure, including placement of the epidural catheter (EDC), was longer in group I than in group II (p = 0.016). This was also observed for the mean length of the surgical procedure itself (p = 0.031). Most patients in group I had EDC (n = 38) (p = 0.001). Patients in group I required more medication for pain control (p = 0.022). A lower position of the diaphragm was achieved in all patients (p < 0.001). The length of hospital stay was 7 (SD ± 4.5) days in group I vs. 4.5 (SD ± 3.2) days in group II (p = 0.036). Minor complications occurred in 3% (n = 4) in group I vs. 2% (n = 3) in group II. No mortality was observed in any of the groups. Postoperative follow-up of patients at 6, 12, and 24 months showed a significant increase in forced vital capacity (FVC) up to 25% (SD ± 10%–35%) (p = 0.019), in forced expiratory volume in 1 s (FEV1) up to 20% (SD ± 12%–38%) in both groups (p = 0.026), also in the diffusion capacity of carbon monoxide (DLCO) up to 15% (SD ± 10%–20%) was noticed in both groups. Chronic pain symptoms were noted in 13% (n = 6) in group I vs. 2% (n = 2) in group II (p = 0.014). Except for one patient in group II, no recurrence of DE was observed. Conclusions: Diaphragm plication is an effective procedure to reduce debilitating dyspnea and improve lung function in patients suffering from diaphragm eventration. Minimally invasive diaphragmatic plication using VATS procedures is a safe and feasible procedure for the management of unilateral diaphragmatic paralysis. VATS-DP is superior to open procedure in terms of pain management and length of hospital stay, hence, accelerated recovery is more likely. Careful patient selection is crucial to achieving optimal outcomes. Prospective studies are needed to validate these results.

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Section: Discussionmentioning

confidence: 99%

Minimally-Invasive Diaphragmatic Plication in Patients with Unilateral Diaphragmatic Paralysis

Beshay¹,

Abdel-Bary

Kösek

et al. 2023

JCM

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“…[ 16 19 ] This is because concurrent massive haemothorax in the blunt mechanism may mask the diaphragmatic injury and thus make the detection of bowel in the thoracic cavity on clinical evaluation and imaging difficult. [ 5 7 16 ]…”

Section: Discussionmentioning

confidence: 99%

“…There had been a similar report of herniated bowel into the chest through the diaphragmatic defect getting injured by the trocar during the chest tube insertion or the bowel becoming incarcerated and, subsequently, perforate due to transmural ischemia. [ 7 23 ] Either the trocar or the herniation of the bowel through the diaphragmatic defect may have been responsible for the bowel injury.…”

Section: Discussionmentioning

confidence: 99%

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Management of traumatic diaphragmatic injury—A peep into bowel repair via thoracotomy

Okonta¹,

Ekwunife²,

Okonta³

et al. 2022

J West Afr Coll Surg

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Background: Traumatic diaphragmatic injury (TDI) is a relatively rare condition, and there is a high tendency for it to be missed if thorough clinical assessment and imaging review are not carried out. The surgical approach for TDI can be challenging, especially with bowel perforation. Materials and Methods: This is a retrospective case series of all consecutive patients with TDI from two tertiary hospitals in the southern part of Nigeria between January 2013 and December 2019. The demographic data of the patients, type, cause, and clinical diagnosis, intraoperative findings, Injury Severity Score, and outcome were noted. The descriptive statistics were presented in percentages and fractions. Results: Fourteen (4.3%) of the 326 chest trauma patients had TDI with 57.1% from penetrating causes and 42.9% from blunt causes. The causes of the TDI were gunshot injuries (42.9%), road traffic crashes (35.7%), stab injury (14.3%), and domestic accidents (7.1%). The preoperative method of diagnosis was mainly by massive haemothorax necessitating open thoracotomy (42.9%) and mixed clinical evaluation, chest radiograph, and upper gastrointestinal contrast studies (35.7%), and the drainage of intestinal content following the insertion of a chest tube to initially drain haemothorax (21.4%) and other modality of diagnoses (7.1%). The operative finding was mainly intestine content in the chest (50%) and only diaphragmatic injury (35.7%). The major complication after surgery was empyema thoracis (14.3%) and the mortality rate (14.3%). Conclusion: Penetrating injury of the chest was the major factor responsible for the TDI, and even with bowel perforation and acute TDI, thoracotomy offered an effective surgical approach for all the patients.

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“…3 The surgery involves repositioning and/or reshaping the elevated portion of the hemidiaphragm or the entire hemidiaphragm that allows for greater expansion of lungs resulting in improvement in pulmonary functions, symptoms, and quality of life. 3 4 However, the surgery can also be associated with postoperative complications that affect a patient's functional capacity, increased hospital length of stay, and overall health care costs. 4 5 Thus, this study aims at determining the potential benefits of early physical therapy interventions in a patient following diaphragmatic plication.…”

Section: Introductionmentioning

confidence: 99%

Early Physical Therapy Management of a Patient with Diaphragmatic Eventration Following Diaphragmatic Plication: A Case Report

Prajapati,

Ashok

2024

Journal of Health and Allied Sciences NU

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Diaphragmatic plication is the recommended surgical procedure for the treatment of diaphragmatic eventration in those who have failed conservative care. The present case report describes a 63-year-old male patient who presented with breathlessness on exertional activities. Chest X-ray and Computed Tomography (CT) of the thorax revealed diaphragmatic eventration on the right side. After failed conservative management, the patient underwent diaphragmatic plication surgery and was followed up with postoperative physical therapy management. Physical therapy intervention was started from 3 days postsurgery and was continued for 1 week. The treatment goals focused on reducing breathlessness, reducing pain on the incision site, preventing postoperative complications, and improving functional capacity. The present study highlights the benefits of early physical therapy interventions including incentive spirometer, dyspnea relieving techniques, Transcutaneous Electrical Nerve Stimulation (TENS), and light- to moderate-intensity aerobic exercises in the patient after plication surgery.

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Grave thoraco-intestinal complication secondary to an undetected traumatic rupture of the diaphragm: a case report

Cited by 4 publications

References 19 publications

Minimally-Invasive Diaphragmatic Plication in Patients with Unilateral Diaphragmatic Paralysis

Minimally-Invasive Diaphragmatic Plication in Patients with Unilateral Diaphragmatic Paralysis

Management of traumatic diaphragmatic injury—A peep into bowel repair via thoracotomy

Early Physical Therapy Management of a Patient with Diaphragmatic Eventration Following Diaphragmatic Plication: A Case Report

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