Imaging of Traumatic Diaphragmatic Rupture: Evaluation of Diagnostic Accuracy at a Level 1 Trauma Centre

Leung, Vincent; Patlas, Michael N.; Reid, Susan; Coates, Angela; Nicolaou, Savvas

doi:10.1016/j.carj.2015.02.001

Cited by 25 publications

(22 citation statements)

References 26 publications

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“…Laparoscopy for abdominal trauma is useful in the diagnosis of diaphragmatic rupture, an often missed injury. 14,15 Lin et al 16 have described a new approach for management of high-grade splenic injury laparoscopically. They, however, emphasize the need for adequate training on laparoscopy in trauma.…”

Section: Resultsmentioning

confidence: 99%

Laparoscopy in Blunt Abdominal Trauma

Nnamonu¹

2017

WJOLS

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Introduction: This review describes the role of laparoscopy in patients with blunt abdominal trauma. Materials and methods:Keywords, such as laparoscopy, blunt, abdominal, trauma were entered into PubMed search engine and filtered for peer-reviewed articles written in the last 5 years. Results and discussion:The findings from these articles are collated and discussed. Conclusion:Laparoscopy is a safe approach both for diagnosis and treatment of patients with blunt abdominal trauma and is associated with the benefits of laparoscopic approach.

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Section: Resultsmentioning

confidence: 99%

Laparoscopy in Blunt Abdominal Trauma

Nnamonu¹

2017

WJOLS

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“…[1][2][3][4][5][6][7][8][9][10][11][12][13] Trae aparejada una tasa de mortalidad no despreciable, que oscila entre el 6% y el 40% de los casos registrados. 4,5,9 Debido a. Radiografía de tórax al momento del ingreso.…”

Section: Discusión Y Conclusionesunclassified

“…2,7,11 La tomografía cobra un rol protagónico, entonces, con buena sensibilidad y especificidad para el diagnóstico. 13 La Asociación Americana de Cirugía de Trauma adopta una clasificación de las lesiones diafragmáticas en cinco grupos, en función del área muscular comprometida, que está basada en los trabajos publicados por Moore et al 14 Sin embargo, sus bases se fundamentan en la población adulta, por lo que no es por completo extrapolable a la población pediátrica, que varía significativamente en talla y circunferencia torácica de acuerdo con el rango etario.…”

Section: Figura 3 Defecto Diafragmático (Señalado Por La Pinza) Luegunclassified

“…Se presenta en forma infrecuente, con una incidencia que varía entre menos del 1% y el 8% de los traumatismos cerrados en las distintas series. [1][2][3][4][5][6][7][8][9][10][11][12][13] Solo entre el 25% y el 50% de los casos es detectado en la evaluación inicial del paciente, lo que aumenta el riesgo de complicaciones asociadas, tales como la oclusión intestinal o la perforación de víscera hueca, con consecuencias significativas en la evolución del paciente y alta tasa de mortalidad, que puede ascender hasta el 40%. 4,5,9 Dado que, en la mayor parte de los casos, el mecanismo causal es un traumatismo toracoabdominal de alto impacto, otras lesiones asociadas acompañan esta entidad casi en la totalidad de los casos.…”

Section: Introductionunclassified

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Ruptura diafragmática postraumática en pediatría. A propósito de un caso

Lerendegui

Gauto

Esnaola

et al. 2018

Arch Argent Pediatr

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Arch Argent Pediatr 2018;116(2):e292-e295 / e292Presentación de casos clínicos RESUMEN La ruptura diafragmática es una entidad relativamente infrecuente en pediatría que se puede presentar como consecuencia de un traumatismo de alto impacto. Solo entre el 25% y el 50% de los casos es detectado en la evaluación inicial del paciente, lo que aumenta el riesgo de complicaciones. En este trabajo, se presenta el caso de una paciente asintomática, de 8 años de edad, que, tras un accidente vehicular y la evaluación inicial en otro centro, fue derivada a nuestra Institución para el control evolutivo. A las 36 horas del ingreso, presentó hipoventilación pulmonar izquierda. La tomografía demostró un ascenso intratorácico del ángulo esplénico del colon y asas de intestino delgado. Se efectuó la exploración y el tratamiento quirúrgico. Los controles radiográficos diferidos no mostraron signos de recidiva. Palabras clave: ruptura diafragmática, traumatismo múltiple, hernia diafragmática, pediatría.ABSTRACT Diaphragmatic rupture is a relatively uncommon entity in pediatrics that can occur as a result of a high-impact trauma. Only between 25 and 50% of the cases are detected in the initial evaluation of the patient, which increases the risk of complications. This paper presents the case of an asymptomatic 8-year-old patient who was referred to our institution after a vehicular accident. A day and a half after admission, a left pulmonary hypoventilation was detected. Computed tomography scan showed intrathoracic elevation of the splenic angle of the colon and the small bowel. Surgical exploration and treatment were performed. Deferred radiographic controls showed no signs of relapse.

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“…Diaphragmatic hernia is a rare but serious complication of trauma that may lead to significant morbidity and mortality if unrecognized. Conservative estimates suggest that the incidence of diaphragmatic injury is 0.8%-8% from blunt abdominal trauma and 10%-15% after penetrating trauma, with more extensive diaphragmatic injuries associated with blunt trauma [1][2][3][4]. The true incidence of traumatic diaphragmatic hernia (TDH) remains uncertain as the wide variety in clinical presentations leads to diagnostic challenges [1,2,[5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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

Gribben

Ilonzo

Neifert

et al. 2019

Journal of Scientific Innovation in Medicine

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Background: Diaphragmatic hernia is a complication of trauma that may lead to significant morbidity and mortality if unrecognized. The clinical sequelae following missed traumatic diaphragmatic hernia (TDH) diagnoses have not been well-defined. Methods: The 2005-2015 ACS-NSQIP databases were accessed to identify patients ≥18 years old who underwent operative repair of acute and chronic TDH. Patient demographics, health characteristics, pertinent complications, and 30-day outcomes were collected. Categorical variables were analyzed using chi-square and Fisher's Exact Test. Logistic regression was used to perform multivariate analyses with odds ratios (OR) and 95% confidence intervals (CI) constructed about group differences. Results: From 2005-2015, 1000 patients underwent operative repair for TDH, of which 285 (28.5%) were acute and 715 (71.5%) were chronic. Patients undergoing acute repairs had a greater percentage of emergency procedures (29.8% vs. 10.2%, p < 0.0001). Acute TDH patients were more likely to be male (46.7% vs 37.2%, p = 0.01) and have concomitant infection (14.0% vs 6.6%, p = 0.0002). Chronic TDH patients were more likely to be obese (55.2% vs 42.8%, p = 0.0004) and have an ASA > 2 (51.2% vs 43.2%, p = 0.02). Acute TDH patients were more likely to develop postoperative wound infection (1.40% vs 0.28%, p = 0.05), infectious process (11.2% versus 7.0%, p = 0.03), failure to wean from mechanical ventilation (8.1% vs 3.4%, p = 0.0015), and remain hospitalized at 30 days (4.3% vs 0.9%, p = 0.0058). Conclusions: Patients with acute TDH repair are more likely to develop postoperative complications. Further study is necessary to determine the optimal timing of surgery for TDH discovered following initial resuscitation and evaluation.

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Imaging of Traumatic Diaphragmatic Rupture: Evaluation of Diagnostic Accuracy at a Level 1 Trauma Centre

Abstract: The detection of TDR in trauma patients on 64-MDCT can be improved, especially in patients presenting with penetrating injury. A careful search for subtle diaphragmatic defects and indirect evidence of injury is important to avoid missing the diagnosis.

Cited by 25 publications

References 26 publications

Laparoscopy in Blunt Abdominal Trauma

Laparoscopy in Blunt Abdominal Trauma

Ruptura diafragmática postraumática en pediatría. A propósito de un caso

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

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