Tension pneumothorax and life saving diaphragmatic rupture: a case report and review of the literature

Abstract

A tension pneumothorax is a known life-threatening condition which requires a needle decompression. A diaphragmatic rupture is a relatively rare injury and is difficult to diagnose. A combination of a tension pneumothorax in presence of an ipsilateral diaphragmatic rupture can be called life-saving since the air in the pleural space is able to escape to the abdomen. The diagnosis of a diaphragmatic rupture by computed tomography or even by laparo- or thorascopy is crucial. Surgical repair should always be undertaken because the rupture will not close spontaneously and the risk of herniation of intra-abdominal organs to the pleural space will remain. In presence of a chest tube on suction, iatrogenic migration or even perforation of these organs can occur.

A Case of Traumatic Diaphragm Rupture: A Differential Diagnosis Not to Miss

“…Approximately 3% of abdominal injuries are attributed to this type of injury, with a ratio of 2:1 for penetrating to blunt trauma. Left-sided injuries occur twice as frequently as right-sided injuries, likely due to the protective effect of the liver on the right hemidiaphragm [ 13 ]. While most cases are linked to high-velocity motor vehicle accidents, even accidents such as falls from heights, as in our case, can lead to this type of injury [ 1 - 3 ].…”

“…Possible complications of missed diaphragmatic hernias managed as tension pneumothorax include iatrogenic colonic perforation as a result of chest tube management. For cases of diaphragmatic hernias presenting similarly to tension pneumothorax, tension fecopneumothorax is a rare entity that occurs as a result of prolonged negative suction from a chest tube on an injured diaphragm, leading to subsequent herniation and perforation of the transverse colon [ 13 ].…”