Delayed traumatic diaphragmatic rupture: diagnosis and surgical treatment

Zhao, Luo; Han, Zhijun; Liu, Huan; Zhang, Zhiyong; Li, Shanqing

doi:10.21037/jtd.2019.07.14

Cited by 23 publications

(37 citation statements)

References 7 publications

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“…In cases of delayed diagnosis, an alternative transthoracic approach may offer some benefit because intra-abdominal adhesions and inflammation may lead to a more difficult repair via an abdominal approach [4]. In a recent retrospective analysis of 40 patients with a delayed diagnosis of traumatic diaphragmatic rupture, Zhao et al found 38 (95%) patients were successfully repaired with a thoracotomy approach, with a recurrence rate of 2.6% at 2-yearsfollow-up, which was repaired with a polypropylene mesh to decrease the tension via a thoracotomy approach [12]. However, as pointed out by Furak et al, multiple approaches can be utilized for chronic traumatic diaphragmatic rupture, including transthoracic, transabdominal, thoracoabdominal, or minimally invasive thoracoscopy, and the choice mainly depends on surgeon experience [4].…”

Section: Discussionmentioning

confidence: 99%

Traumatic Diaphragmatic Rupture with Transthoracic Organ Herniation: A Case Report and Review of Literature

et al. 2020

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Rare disease Background: Diaphragmatic rupture is a rare pathology that reported in less than 0.5% of all trauma cases, with signs and symptoms that can easily be misdiagnosed. Clinicians must maintain a high index of suspicion to correctly diagnose and manage this pathology. We present a rare case of a large diaphragmatic rupture with transthoracic gastric and colon herniation that was successfully repaired, along with a literature review. Case Report: A 59-year-old woman presented to our Trauma Center after being involved in a motor vehicle collision. She complained of chest and abdominal pain, with decreased breath sounds on the left side. CT imaging revealed discontinuity of the left hemidiaphragm, with intrathoracic herniation of stomach and colon with multiple other injuries. The patient was taken for an emergent laparotomy. The diaphragmatic rupture measured 20 cm in length, with a stellate component. After ensuring complete reduction of the herniated organs, the diaphragmatic defect was primarily repaired. The patient recovered from her injuries and was doing well at last followup in the clinic. Conclusions: This case highlights the importance of diaphragmatic rupture and its associated intra-abdominal injuries when treating trauma patients. With missed diaphragmatic injuries leading to a potential morbidity rate of 30% and mortality rate as high as 10%, the clinician must have a high index of suspicion to correctly diagnose and manage this pathology in a timely fashion. More research is needed to provide surgeons with evidence-based standardized therapies for dealing with these rare pathologies to ensure optimal patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Traumatic Diaphragmatic Rupture with Transthoracic Organ Herniation: A Case Report and Review of Literature

et al. 2020

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“…Only 20% of blunt traumatic diaphragmatic injuries occur on the right side [2,3,[5][6][7]. The functional anatomy of the diaphragm is the reason behind both the rarity and the diagnostic difficulty of right-sided traumatic diaphragmatic injury.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, when right-sided diaphragmatic ruptures do occur, the dome of the liver can act as a seal of the diaphragmatic defect. This poses significant challenges to the early radiological visualization of the injury and, in association with a lack of immediate symptoms, can be falsely reassuring [6,8].…”

Section: Discussionmentioning

confidence: 99%

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Total thoracic herniation of the liver: a case of delayed right-sided diaphragmatic hernia after blunt trauma

et al. 2020

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Background: Traumatic diaphragmatic injuries (TDIs) are relatively uncommon and require surgical repair to prevent or address herniation. Three quarters of TDIs are due to blunt thoraco-abdominal trauma. In blunt TDIs, variable clinical presentations and frequent concurrent life-threatening injuries may hinder early recognition and treatment, leading to diagnostic delays, which may result in technically more challenging repairs. Right-sided blunt TDIs are much less common than left-sided ones, are difficult to visualize on imaging studies, are more frequently associated with other potentially lethal injuries, and tend to present more subtly, so that diagnostic delays are more likely. Case presentation: We report the diagnosis and elective repair of a large right-sided traumatic diaphragmatic hernia resulting from a distant blunt abdominal injury, describing the techniques used to address the challenges presented by the chronic intrathoracic displacement of the entire liver with the gallbladder, as well as the right side of the colon and part of the duodenum. Conclusions: Early diagnosis of right-sided TDIs can be especially elusive. The management of delayed diaphragmatic hernias can be challenging, but with meticulous planning and a flexible surgical approach, a repair can be achieved resulting in good recovery and low risk of recurrence.

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“…19 Thus, for a delayed diaphragmatic rupture, it was also hypothesized that most patients with delayed diaphragmatic ruptures had no acute TDR. The diaphragmatic muscle became devitalized several days or months after the initial injury 7,20 resulting in its later lysis. 21 Therefore, X ray of chest is often not diagnostic initially due to slow herniation of abdominal contents through the diaphragm and requires follow up with serial X Rays 6,22 or CTs if they are available.…”

Section: Section: Surgerymentioning

confidence: 99%

Traumatic Diaphragmatic Rupture – A Clinical Experience Over Two Decades

Dasbaksi¹,

Haldar²,

Mukherjee³

2019

IJCMR

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Introduction: Traumatic diaphragmatic rupture was once only reported in post mortem findings. But due to better advanced trauma and life support services and increased survival of the trauma patients, these are now diagnosed with increasing frequency. The purpose of this study was to present our experience with its different mechanisms of rupture and its management. The aim of this retrospective study was to evaluate manifestations of effects of diaphragmatic rupture after thoraco-abdominal trauma, and to discuss their epidemiology, diagnosis, nature and treatment with an aim to impart comprehensive timely management to reduce morbidity and mortality. Material and methods: It is the report of combined experience of the authors on 18 patients with traumatic diaphragmatic rupture with (TDR) or without traumatic diaphragmatic hernia (TDH) treated in two Medical College Hospitals in Kolkata, from 1998 to 2019, and a retrospective analysis was performed. 9 patients who presented with severe injury with features of internal injury were operated early and 9 with non severe injury were operated later. Results: Out of 18 patients, 14 had history of blunt trauma and 4 had history of penetrating trauma. 4 patients with penetrating together with 5 with blunt injury were included in the severe group and had undergone early surgery due to suspected internal injuries. Out of these 9 patients, 5 patients having TDR and 1 having TDH died due hemorrhage and / or sepsis with a mortality of 33.33. TDH was diagnosed by imaging studies in 9 patients in non severe group while 1 was diagnosed intra operatively in the severe group. Conclusions: Though priority of a blunt or a penetrating trauma patient involves resuscitation and early surgery when indicated, careful understanding of mechanism of injury can guide the emergency surgeon to suspect and examine the diaphragm for any TDR to prevent further complication. In addition to X rays computer tomographic study when available becomes helpful in preoperative planning of surgery for closure of TDR or TDH.

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Delayed traumatic diaphragmatic rupture: diagnosis and surgical treatment

Cited by 23 publications

References 7 publications

Traumatic Diaphragmatic Rupture with Transthoracic Organ Herniation: A Case Report and Review of Literature

Traumatic Diaphragmatic Rupture with Transthoracic Organ Herniation: A Case Report and Review of Literature

Total thoracic herniation of the liver: a case of delayed right-sided diaphragmatic hernia after blunt trauma

Traumatic Diaphragmatic Rupture – A Clinical Experience Over Two Decades

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