Diaphragmatic rupture: Is management with biological mesh feasible?

Al-Nouri, Omar; Hartman, Brett; Freedman, Robert J.; Thomas, Casey; Esposito, Thomas J.

doi:10.1016/j.ijscr.2012.04.011

Cited by 23 publications

(26 citation statements)

References 20 publications

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“…Diaphragmatic transposition 25 as well as biologic and permanent mesh placement 9 have been used for complex injuries. 9,25 There are several limitations of our study. Although the majority of TDI were repaired with open techniques, we documented increased use of minimally invasive repairs in both blunt and penetrating groups.…”

Section: Discussionmentioning

confidence: 99%

Evolution in the management of traumatic diaphragmatic injuries

Ties

Peschman

Moreno

et al. 2014

Journal of Trauma and Acute Care Surgery

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Section: Discussionmentioning

confidence: 99%

Evolution in the management of traumatic diaphragmatic injuries

Ties

Peschman

Moreno

et al. 2014

Journal of Trauma and Acute Care Surgery

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“…However, it is critical to recall that right sided ruptures are associated with greater extent of injuries to vital structures and higher mortality rates due to the close proximity of the liver, portal vein, inferior vena cava. [3,4,15,16] The principal pathophysiological phenomena following a diaphragmatic rupture are insufficiency of the diaphragm, compression of the lungs from herniated viscera, mediastinal displacement and decreased venous return. [3,16] The position of the diaphragm and its anatomic relationship with intrathoracic and visceral organs can explain the high proportion of lesions associated, observed in 52-100% of cases.…”

Section: Discussionmentioning

confidence: 99%

“…[1] The incidence of traumatic diaphragmatic rupture secondary to blunt trauma, most commonly motor vehicle collisions, ranges from 0.8-8% in patients who had undergone thoracotomy or laparotomy for repair of visceral injuries [2,3]. Diaphragmatic rupture is a potentially life threatening clinical condition [4,19] both due to the lack of apparent clinical signs and diagnostic delays. Associated injury to abdominal organs is common during blunt trauma and may obscure the presentation of a concomitant diaphragmatic rupture.…”

Section: Introductionmentioning

confidence: 99%

A Case Report on Diaphragmatic Rupture, in the Visceral Surgery of Hospital of Conakry, Guinea

Balde¹

2016

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The aim of this case report is to share our experience in the management of this this rare case of traumatic diaphragmatic rupture in the visceral surgery department of the Hospital of Conakry. Traumatic diaphragmatic rupture is an unfamiliar diagnosis to make and exceptionally seen in some cases of high velocity injuries which involve the abdomen. The high energy from blunt trauma transmitted across the abdomen gives rise to an excessively high pressure in the abdominal cavity which causes shearing of the diaphragmatic muscle. It is indeed considered as a surgical emergency as impaired diaphragmatic movement has a big impact on ventilation and oxygenation of blood. The delay in making appropriate diagnosis due to the lack of overt clinical signs relating to this type of injury accounts for the high mortality rates reaching 31%. We are reporting on a case concerning a 28-year old male patient who was admitted at the department of visceral surgery at the National Hospital of Donka, Conakry, Guinea, for emergency evaluation and treatment of a left sided traumatic diaphragmatic rupture associated with eventration of viscera into the thoracic cavity and contusion of the ascending colon. The mechanism of rupture was determined as a force vector directed frontally and was transmitted across the diaphragmatic wall. A clinical diagnosis was made and confirmed by radiological imaging preoperatively. Prompt surgical intervention was provided within the 1 st 24 hours from the time of admission. No complications had been encountered during the post-operative recovery period. The best way to evaluate traumatic diaphragmatic rupture in a patient is through a well-devised systematic approach. It is not advised to perform lengthy imaging tests in a hemodynamically unstable patient and thus, compromising the success of the surgical outcome.

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“…This method is effective in the setting of chronic injury repairs but is limited in the setting of an acute TDI with a contaminated field. Alternative methods in a contaminated field include the use of biologic mesh, vascularized tissue flaps, or a temporary absorbable mesh with plans for a delayed reconstruction [54][55][56][57]. A final challenging (although uncommon) situation is diaphragmatic avulsion from its attachments to the chest wall.…”

Section: Managementmentioning

confidence: 99%

“…In select cases where the stomach is the incarcerated organ, reduction or detorsion can be performed endoscopically and maintained with a nasogastric tube, converting an emergent procedure to a semi-elective intervention. Defects that are too large or result in flattening of the diaphragm should be repaired using a prosthetic or biologic mesh to achieve a tension-free repair, or one of the other reconstructive options described previously for grade 3 to 5 defects [31,55].…”

Section: Long-term Outcomes and Chronic Diaphragmatic Herniamentioning

confidence: 99%

Penetrating Traumatic Diaphragm Injuries

DeBarros

Martin

2015

Curr Trauma Rep

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Traumatic diaphragm injuries (TDI) are uncommon but can result in major morbidity or mortality if missed. Penetrating thoracoabdominal injuries carry a high risk of TDI, but can also pose a diagnostic dilemma due to their small size and the frequent lack of an associated hernia. Despite advances in imaging, diagnosis without presence of a hernia remains difficult and a high index of suspicion must be maintained. Chest x-ray remains an important tool in early diagnosis, but primarily relies on the presence of a hernia or a discontinuity of the diaphragm, which is not typically seen with penetrating injuries. Computed tomography has a higher sensitivity and specificity and improves preoperative diagnosis, but most TDI are still diagnosed intra-operatively. Minimally invasive modalities allow for both diagnosis and repair of suspected injuries in hemodynamically stable patients while avoiding the morbidity of an open approach. All penetrating diaphragmatic injuries require repair in order to avoid the major morbidity and mortality of a chronic diaphragmatic hernia. The principles of diaphragmatic injury repair are complete reduction of all abdominal contents, lavage and evacuation of any associated hemothorax or gastrointestinal spillage, and watertight, tension-free closure. Most injuries can be closed primarily, but some may require use of prosthetic material or other advanced reconstructive techniques for larger defects. Mortality remains primarily dependent on the mechanism of injury and the presence and severity of associated injuries, with overall Injury Severity Score serving as an independent predictor of early mortality.

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Diaphragmatic rupture: Is management with biological mesh feasible?

Cited by 23 publications

References 20 publications

Evolution in the management of traumatic diaphragmatic injuries

Evolution in the management of traumatic diaphragmatic injuries

A Case Report on Diaphragmatic Rupture, in the Visceral Surgery of Hospital of Conakry, Guinea

Penetrating Traumatic Diaphragm Injuries

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