Early recognition of diaphragmatic injuries from blunt trauma

Troop, Bryan; Myers, Roy A.M.; Agarwal, Nikileshwer N

doi:10.1016/s0196-0644(85)81068-4

Cited by 29 publications

(6 citation statements)

References 10 publications

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“…Correct diagnosis of this potentially lethal condition continues to require a high index of suspicion (3). Surgical intervention must be provided promptly because the patient's clinical course may rapidly deteriorate with bowel strangulation, obstruction, hemorrhage and perforation, as well as empyema and pleural fistula (4).…”

Section: Abstract: Acute Ileus; Bowel Obstruction; Deviated Mediastimentioning

confidence: 99%

Delayed Diaphragmatic Herniation Masquerading as a Complicated Parapneumonic Effusion

Tsang

Ryan

1999

Canadian Respiratory Journal

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Injury to the diaphragm following blunt or penetrating thoracoabdominal trauma is not uncommon. Recognition of this important complication of trauma continues to be a challenge because of the lack of specific clinical and plain radiographic features, the frequent presence of other serious injuries and the potential for delayed presentation. Delayed diaphragmatic herniation often presents with catastrophic bowel obstruction or strangulation. Early recognition of diaphragmatic injury is required to avoid this potentially lethal complication. The case of a 35-year-old man with a history of a knife wound to the left flank 15 years previously, who presented with unexplained acute hypoxemic respiratory failure and a unilateral exudative pleural effusion that was refractory to tube thoracostomy drainage, is reported. After admission to hospital, he developed gross dilation of his colon; emergency laparotomy revealed an incarcerated colonic herniation into the left hemithorax. Interesting clinical features of this patient's case included the patient's hobby of weightlifting, a persistently deviated mediastinum despite drainage of the pleural effusion and deceptive pleural fluid biochemical indices. Key Words: Acute ileus; Bowel obstruction; Deviated mediastinum; Pleural effusion; WeightliftingConfusion entre épanchement parapneumonique compliqué et hernie diaphragmatique tardive RÉSUMÉ : L'atteinte diaphragmatique n'est pas rare après un traumatisme thoraco-abdominal fermé ou pénétrant. La reconnaissance de cette importante complication des traumatismes continue de représenter un défi, compte tenu de l'absence de caractéristiques spécifiques sur les plans des symptômes cliniques et des clichés radiologiques simples, de la présence fréquente d'autres lésions graves et du risque que les manifestations apparaissent tardivement. L'hernie diaphragmatique tardive s'accompagne souvent d'une dangereuse obstruction ou strangulation intestinale. Le diagnostic précoce de cette lésion diaphragmatique est nécessaire pour éviter une complication potentiellement fatale. Le cas présenté ici est celui d'un homme de 35 ans ayant subi 15 ans auparavant une blessure à l'arme blanche au côté gauche; il se présente pour insuffisance respiratoire hypoxémique aiguë inexpliquée et épanchement pleural exsudatif bilatéral réfractaire au traitement par thoracotomie. Après son admission à l'hôpital, il a présenté une dilatation marquée du côlon. La laparotomie d'urgence a révélé une hernie irréductible du côlon dans l'hémithorax gauche. Parmi les caractéristiques intéressantes de ce cas, mentionnons le passetemps du patient, haltérophile, un médiastin présentant une déviation persistante malgré le drainage de l'épanchement pleural et les indices biochimiques trompeurs du liquide pleural.T raumatic injury and subsequent herniation through the diaphragm was first described over 400 years ago (1), and the first successful repair was reported in 1886 (2). Correct diagnosis of this potentially lethal condition continues to require a high index of suspic...

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Section: Abstract: Acute Ileus; Bowel Obstruction; Deviated Mediastimentioning

confidence: 99%

Delayed Diaphragmatic Herniation Masquerading as a Complicated Parapneumonic Effusion

Tsang

Ryan

1999

Canadian Respiratory Journal

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“…It is reported that 77~95% of cases of diaphragmatic rupture were caused by blunt wounds, and 12.3% were caused by stab wounds [2]. Another study showed that the morbidity of diaphragmatic rupture was low, at 0.8~1.6%, though it has been concluded that the morbidity rate is likely higher than reported statistics because it is difficult to compile accurate statistics on diaphragmatic rupture by chest radiographs and other findings [3]. Diaphragmatic rupture by blunt wounds is an indicator of the severity of injury because it generally accompanies injuries to other organs.…”

Section: Introductionmentioning

confidence: 99%

Management of Patients with Traumatic Rupture of the Diaphragm

Hwang

Kim

Byun

2011

Korean J Thorac Cardiovasc Surg

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BackgroundTraumatic rupture of the diaphragm is an unusual type of trauma. In addition, it is difficult to diagnose because it can be accompanied by injuries to other organs. If it is not detected early, the mortality rate can increase due to serious complications. Diaphragmatic rupture is an important indicator of the severity of the trauma. The aim of this study was to investigate the factors affecting the incidence of complications and mortality in patients who had surgery to treat traumatic rupture of the diaphragm.Materials and MethodsThe subjects were patients who had undergone a diaphragmatic rupture by blunt trauma or stab wounds except patients who were transferred to other hospitals within 3 days of hospitalization, from January 2000 to December 2007. This study was a retrospective study. 43 patients were hospitalized, and 40 patients were included during the study period. Among them, 28 were male, 12 were female, and the average age was 42 (from 18 to 80). Outcome predictive factors including hypoxia, ventilator application days, revised trauma score (RTS), injury severity score (ISS), age, herniated organs, complications, and the mortality rate were investigated.ResultsCauses of trauma included motor vehicle crashes for 20 patients (50%), falls for 10 (25%), stab wounds for 8 (20%), and agricultural machinery accidents for 2 (5%). Most of the patients (36 patients; 90%) had wound sites on the left. Diagnosis was performed within 12 hours for most patients. The diaphragmatic rupture was diagnosed preoperatively in 27 patients (70%) and in 12 patients (30%) during other surgeries. For surgical treatment, thoracotomy was performed in 14 patients (35%), laparotomy in 11 (27.5%), and a surgery combining thoracotomy and laparotomy in 15 patients (37.5%). Herniated organs in the thoracic cavity included the stomach for 23 patients (57.5%), the omentum for 15 patients (37.5%), the colon for 10 patients (25%), and the spleen for 6 patients (15%). Accompanying surgeries included splenectomy for 13 patients (32.5%), lung suture for 6 patients (15%), and liver suture for 5 patients (12.5%). The average hospital stay was 47.80±56.72 days, and the period of ventilation was 3.90±5.8 days. The average ISS was 35.90±16.81 (11~75), and the average RTS was 6.46±1.88 (1.02~7.84). The mortality rate was 17.5% (7 patients). Factors affecting complications were stomach hernia and age. Factors affecting the mortality rate were ISS and RTS.ConclusionThere are no typical symptoms of the traumatic rupture of the diaphragm by blunt trauma. Nor are there any special methods of diagnosis; in fact, it is difficult to diagnose because it accompanies injuries to other organs. Stab wounds are also not easy to diagnose, though they are relatively easy to diagnose compared to blunt trauma because the accompanying injuries are more limited. Suture of the diaphragm can be performed through the chest, the abdomen, or the thoracoabdomen. These surgical methods are chosen based on accompanying organ injuries. When there are many organ injuri...

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“…The chest radiograph seems to be the most useful investigation in such cases. 12,13 Thoracic ultrasonography and CT are other methods that could establish the diagnosis.…”

Section: Discussionmentioning

confidence: 99%