Chronic traumatic diaphragmatic hernia with pericardial rupture and associated gastroesophageal reflux

Abstract

Major thoracic and abdominal trauma damages the diaphragm 5% of the time. These injuries may be recognized when they occur but often are discovered months later during work up for related symptoms. Typically, the injury is to the left posterolateral aspect of the diaphragm. Rarely, rupture through the central diaphragmatic tendon into the pericardial space occurs and this results in different symptoms than the more common injury. We present the case of a patient who presented with chest pain, near syncopal episodes and refractory gastroesophageal reflux years after he was struck by a car and hospitalized. Radiographic imaging included a chest CT that demonstrated herniation of the transverse colon into the mediastinum. During exploration, a defect in the central diaphragm was found with free communication between the peritoneal and pericardial spaces. In this paper, we review our management of this unusual diaphragmatic hernia and the unique symptoms associated with it.

Patient Characteristics and Outcomes Following Operative Repair of Acute versus Chronic Traumatic Diaphragmatic Hernia

“…When identified, however, they should be repaired as such. Our finding underscores the point that traumatic diaphragmatic hernias are often recognized acutely because of their co-occurrence with more life threatening concomitant injuries that warrant surgical exploration and repair [16]. Perhaps these other clinical concerns may have diverted clinicians from evaluating patients for more occult injuries, leading to missed diagnosis of acute diaphragmatic hernias [7,17].…”

Surgical management of diaphragmatic injuries

“…Intrapericardial diaphragmatic injuries and herniation have been reported in the medical literature, most of these are isolated case report 12 . Majority are as a result of motor vehicle accidents and less frequently as a result of the penetrating injuries.…”

Difficult (for diagnosis) case of old posttraumatic diaphragmatic hernia

“…Частота повреждений диафрагмы после травм грудной клетки составляет, по данным литературы, 6,5%, в том числе при открытой травме 5,8% [2]. Обычно поврежде ния выявляются сразу после травмы, но иногда спустя зна чительное время, на стадии сформировавшейся хрониче ской диафрагмальной грыжи [1,6]. Так, по данным G.A.…”