Complicated Diaphragmatic Hernia in Emergency Surgery: Systematic Review of the Literature

Abstract

Introduction Complicated diaphragmatic hernia (DH) can be congenital or acquired. Congenital diaphragmatic hernias (CDH) are rare and often can be asymptomatic until adulthood. Traumatic diaphragmatic hernia (TDH) is a complication that occurs in about 1–5% of victims of road accidents and in 10–15% of penetrating traumas of the lower chest. CDH and TDH are potentially life‐threatening conditions, and the management in emergency setting still debated. This study aims to evaluate the surgical treatment options in emergency setting. Methods A bibliographic research reporting the item “emergency surgery” linked with “traumatic diaphragmatic rupture” and “congenital diaphragmatic hernia” was performed. Several parameters were recorded including sex, age, etiology, diagnosis, treatment, site and herniated organs. Results The research included 146 articles, and 1542 patients were analyzed. Most of the complicated diaphragmatic hernias occurred for a diaphragmatic defect due to trauma, only 7.2% occurred for a congenital diaphragmatic defect. The main diagnostic method used was chest X‐ray and CT scan. Laparotomic approach still remains predominant compared to the minimally invasive approach. Conclusion Surgery is the treatment of choice and is strongly influenced by the preoperative setting, performed mainly with X‐ray and CT scan. Minimally invasive approach is safe and feasible but is highly dependent on the surgeon's expertise, especially in emergency setting.

Diaphragmatic hernia as a rare cause of bowel obstruction

“…In an acute phase, the treatment of intestinal occlusion due to incarcerated diaphragmatic hernia requires respiratory and circulatory resuscitation. Even so, because it is potentially life-threatening, surgery is the treatment of choice in most cases [ 3 , 5 ].…”

Resuscitative thoracotomy for non‐traumatic tension viscerothorax

“…They are classified as congenital or acquired. Congenital hernias are more frequently diagnosed during infancy, whereas acquired hernias usually develop after thoraco‐abdominal trauma and may have early or delayed presetation 1,2 …”

“…Congenital hernias are more frequently diagnosed during infancy, whereas acquired hernias usually develop after thoraco-abdominal trauma and may have early or delayed presetation. 1,2 Diaphragmatic hernias may become clinically evident either with respiratory distress or gastrointestinal complications. 3 Here, we report the case of a 55-year-old woman presented to the emergency department complaining a 4-day history of epigastric pain associated with nausea and vomiting that had worsened over the last 3 h.…”

A Strangulated Congenital Diaphragmatic Bochdalek Hernia Diagnosed in an Adult

“…Occurrence on both sides of the diaphragm is rare [ 3 , 4 ]. Approximately 55–67% of patients with CDH survive [ 5 , 6 ].…”