Tension pneumothorax due to perforated colon

Abdullah, Mohammed A.; Stonelake, Paul S.

doi:10.1136/bcr-2016-215325

Cited by 7 publications

(9 citation statements)

References 17 publications

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“…Faeco-pneumothorax due to perforation of diaphragmatically herniated colon to the pleural cavity is a rare entity, and frequently associated with a tension pneumothorax unmasking the diaphragmatic lesion weeks to decades after the initially undetected injury [6,7]. Nine of a total of 16 cases previously reported were secondary to perforating chest-injuries [3,6,[8][9][10][11][12][13][14] whereas the remaining seven cases had a history of blunt abdominal and/or thoracic injury as happened to our patient [4,7,[15][16][17][18][19]. Empyema is a complication that can develop in the course of these patients, requiring secondary drainage or interventional debridement and is still associated with a mortality of 25-66% [3,4].…”

Section: Discussionmentioning

confidence: 87%

Grave Thoraco-Intestinal Complication Secondary to an Undetected Traumatic Rupture of the Diaphragm - A Case Report

Beshay

Krüger

Singh

et al. 2020

Preprint

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BackgroundDiaphragmatic lesions as a result from blunt or penetrating trauma are challenging to detect in the initial trauma setting. This is especially true when diaphragmatic trauma is part of a polytrauma. Complications of undetected diaphragmatic defects with incarcerating bowel are rare but as in our patient can be serious. Case presentationA 57-year-old female presented to the Emergency Room of our Hospital in a critical condition with 3 days of increasing abdominal pain. The initial clinical examination showed peritonism with tinkling peristaltic bowel sounds of mechanical obstruction. A thoraco-abdominal CT-scan demonstrated colon prolapsed through the left diaphragmatic center with a large sero-pneumothorax under tension. As the patient was hemodynamically increasingly unstable with developing septic shock an emergency laparotomy was performed. After retraction of the left colon, which had herniated through a defect of the tendinous center of the left diaphragm and was perforated due to transmural ischemia, large amounts of feces and gas discharged from the left thorax. A left hemicolectomy resulting in a Hartmann type procedure was performed. A fully established pleural empyema required meticulous debridement and lavage conducted via the 7-10cm in diameter phrenic opening followed by a diaphragmatic defect reconstruction. Due to pneumonia and recurring pleural empyema redo-debridement of the left pleural space via thoracotomy were required. The patient was discharged on day 56. A thorough history of possible trauma revealed a bicycle-fall-trauma 7 months prior to this hospitalization with a surgically stabilized fracture of the left femur and conservatively treated fractures of ribs 3-9 on the left side. ConclusionThis is the first report on a primarily established empyema at the time of first surgical intervention for faeco-pneumothorax secondary to delayed diagnosed diaphragmatic rupture following abdomino-thoracic blunt trauma with colic perforation into the pleural space, requiring repetitive surgical debridement in order to control local and systemic sepsis. Thorough investigation should always be undertaken in cases of blunt abdominal and thoracic trauma to exclude diaphragmatic injury in order to avoid post traumatic complications.

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Section: Discussionmentioning

confidence: 87%

Grave Thoraco-Intestinal Complication Secondary to an Undetected Traumatic Rupture of the Diaphragm - A Case Report

Beshay

Krüger

Singh

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Feco-pneumothorax due to perforation of diaphragmatically herniated colon to the pleural cavity is a rare entity, and frequently associated with a tension pneumothorax unmasking the diaphragmatic lesion weeks to decades after the initially undetected injury [6,7]. Nine of a total of 16 cases previously reported were secondary to perforating chest injuries [3,6,[8][9][10][11][12][13][14], whereas the remaining seven cases had a history of blunt abdominal and/ or thoracic injury as happened to our patient [4,7,[15][16][17][18][19]. Empyema is a complication that can develop in the course of these patients, requiring secondary drainage or interventional debridement and is still associated with a mortality of 25-66% [3,4].…”

Section: Discussionmentioning

confidence: 93%

Grave thoraco-intestinal complication secondary to an undetected traumatic rupture of the diaphragm: a case report

et al. 2021

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Background Diaphragmatic lesions as a result of blunt or penetrating trauma are challenging to detect in the initial trauma setting. This is especially true when diaphragmatic trauma is part of a polytrauma. Complications of undetected diaphragmatic defects with incarcerating bowel are rare, but as in our patient can be serious. Case presentation A 57-year-old female presented to the Emergency Room of our Hospital in a critical condition with 3 days of increasing abdominal pain. The initial clinical examination showed peritonism with tinkling peristaltic bowel sounds of mechanical obstruction. A thoraco-abdominal CT scan demonstrated colon prolapsed through the left diaphragmatic center with a large sero-pneumothorax under tension. As the patient was hemodynamically increasingly unstable with developing septic shock, an emergency laparotomy was performed. After retraction of the left colon, which had herniated through a defect of the tendinous center of the left diaphragm and was perforated due to transmural ischemia, large amounts of feces and gas discharged from the left thorax. A left hemicolectomy resulting in a Hartmann-type procedure was performed. A fully established pleural empyema required meticulous debridement and lavage conducted via the 7–10 cm in diameter phrenic opening followed by a diaphragmatic defect reconstruction. Due to pneumonia and recurring pleural empyema redo-debridement of the left pleural space via thoracotomy were required. The patient was discharged on day 56. A thorough history of possible trauma revealed a bicycle-fall trauma 7 months prior to this hospitalization with a surgically stabilized fracture of the left femur and conservatively treated fractures of ribs 3–9 on the left side. Conclusion This is the first report on a primarily established empyema at the time of first surgical intervention for feco-pneumothorax secondary to delayed diagnosed diaphragmatic rupture following abdomino-thoracic blunt trauma with colic perforation into the pleural space, requiring repetitive surgical debridement in order to control local and systemic sepsis. Thorough investigation should always be undertaken in cases of blunt abdominal and thoracic trauma to exclude diaphragmatic injury in order to avoid post-traumatic complications.

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“…The diagnosis of fecopneumothorax remains clinical in our observation but remains very difficult in cases without pleurocutaneous fistula. The published case reports reveal that 18% of blunt and 32% of penetrating injuries are diagnosed in a delayed fashion, generally more than 3 years after the initial trauma and sometimes as many as 40 years later (15). A systematic review of the literature by Rashid et al revealed 17 cases of delayed presentation of diaphragmatic rupture ranging from a period of 24 hours to 50 years (16).…”

Section: Discussionmentioning

confidence: 99%

“…In a recent study of diagnosis value of CT scan in diaphragmatic injuries, Yucel M and al. have demonstrated greater sensitivity (82%) and specificity (88%) (15,20). For the late phase, the simplest and most practical way to establish the diagnosis is by using immediate chest X-ray along with gastrografin enema (2).…”

Section: Discussionmentioning

confidence: 99%

“…(19) suggested that surgical treatment is mandatory as soon as the diagnosis is established. A combined thoraco abdominal is the reference approach for several authors for diaphragmatic hernia of delayed diagnosis because the herniated contents tend to be firmly adherent to intrathoracic structures, and this is made worse if bowel strangulation and perforation is present (15). Chatzoulis G et al performed an emergency thoracotomy and laparotomy in their case with a favourable result, which resulted in a very heavy operation (10).…”

Section: Discussionmentioning

confidence: 99%

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Pleurocutaneous Fistulas of Fecopneumothorax: Unusual Complications of Penetrating Thoracic Trauma Due to Zebu Gord

Razafimanjato¹,

Tsiambanizafy²,

Ravelomihary³

et al. 2020

Ulutas Med J

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Fecopneumothorax due to acute traumatic diaphragmatic rupture is a rare entity but clinical picture is critical. The systematic review of Tien Yew Chern et al. report 12 cases reports in the literature in the past 50 years (1). We performed a literature research, over the past 20 years, by consulting PubMed/MEDLINE using the terms "fecopneumothorax and chest penetrating injury". The search revealed only four reported cases of colopleural fistula associated with diaphragmatic herniation due to chest injury but none following chest penetrating trauma (1-3). Our second search using the terms "fecopneumothorax and pleurocutaneous fistulas" revealed zero results.

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Tension pneumothorax due to perforated colon

Cited by 7 publications

References 17 publications

Grave Thoraco-Intestinal Complication Secondary to an Undetected Traumatic Rupture of the Diaphragm - A Case Report

Grave Thoraco-Intestinal Complication Secondary to an Undetected Traumatic Rupture of the Diaphragm - A Case Report

Grave thoraco-intestinal complication secondary to an undetected traumatic rupture of the diaphragm: a case report

Pleurocutaneous Fistulas of Fecopneumothorax: Unusual Complications of Penetrating Thoracic Trauma Due to Zebu Gord

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