Surgical management of diaphragmatic injuries

The traumatic rupture of the diaphragm after blunt or penetrating injuries is a well described but uncommon entity. Its presentation in the form of herniated abdominal contents into the thoracic cavity is generally obscure and the recognition of this condition is often challenging. Although many cases remain asymptomatic, significant morbidity and mortality ensues with patients who present with incarceration, strangulation and eventual visceral compromise. Definitive guidelines in the management of traumatic diaphragmatic injuries are still lacking. This report outlines a case of sub-acute presentation of a traumatic diaphragmatic rupture in an elderly female following a motor vehicle accident that required urgent surgical intervention. We reviewed the pertinent literature, with an emphasis on the operative approach and the type of repair of the traumatic diaphragmatic defect.

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“…A later cohort study showed 9% of patients underwent laparoscopy [7], and some centres advocate for VATS repair [8, 9]. …”

Section: Discussionmentioning

confidence: 99%

Traumatic rupture of the diaphragm resulting in the sub-acute presentation of an incarcerated intra-thoracic transverse colon

Kunz

Goh

Stelmach

et al. 2017

Journal of Surgical Case Reports

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“…Despite the advent of new techniques in imaging and surgical interventional therapy, the gold standard for diagnosis and treatment has not been described yet. There is still a considerable amount of misdiagnosis, associated with high mortality and high morbidity [22].…”

Section: Discussionmentioning

confidence: 99%

“…Associated injury to abdominal organs is common during blunt trauma and may obscure the presentation of a concomitant diaphragmatic rupture. The location of the injury is unclear and it it is difficult to discern the extent of injuries, which largely determines the outcome [5,6,22]. An overall mortality of 31% reflects the severity of the trauma [5].…”

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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“…Surgical exploration, however, is mandatory wherever diaphragmatic injury is suspected. Direct suture is effective in preventing future specific complications [24] (Figure 6). …”

Section: Pitfalls Of Ctmentioning

confidence: 99%

A review on Traumatic diaphragmatic ruptur

Lundgren¹,

Sh²,

Ar³

et al. 2017

Trauma Emerg Care

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Historical Vignette: Traumatic diaphragmatic hernia apparently was described by Sennertus, who in 1541 reported an instance of delayed herniation of viscera through an injured diaphragm. The first two deaths were described by Ambrose Paré in 1578, one from strangulated bowel. Ambroise Paré, in 1579, described the first case of diaphragmatic rupture diagnosed at autopsy. The patient was a French artillery captain who initially survived a gunshot wound of the abdomen, but died 8 months later of a strangulated gangrenous colon, herniating through a small diaphragmatic defect that would admit only the tip of the small finger. It was not until 1853 that ante mortem diagnosis of traumatic rupture of diaphragm was made by Bowditch. The first successful diaphragmatic repair was reported by Riolfi in 1886 in a patient with omental prolapse, and Naumann in 1888 repaired the defect with herniated stomach. The largest and the most comprehensive collective review was

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Surgical management of diaphragmatic injuries

Cited by 6 publications

References 5 publications

Traumatic rupture of the diaphragm resulting in the sub-acute presentation of an incarcerated intra-thoracic transverse colon

Traumatic rupture of the diaphragm resulting in the sub-acute presentation of an incarcerated intra-thoracic transverse colon

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

A review on Traumatic diaphragmatic ruptur

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