Traumatic diaphragmatic injuries: a retrospective review of a 12-year experience at a tertiary trauma centre

Lim, Beng Leong; Teo, Li Tserng; Chiu, Ming Terk; Asinas-Tan, Marxengel; Seow, Eillyne

doi:10.11622/smedj.2016185

Cited by 20 publications

(16 citation statements)

References 24 publications

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“…1 Department of Thoracic Surgery, University Hospital OWL of the University Bielefeld, campus Bielefeld-Bethel, Bielefeld, Germany. 2 Department of Internal Medicine and Gastroenterology, University Hospital OWL of the University Bielefeld, campus Bielefeld-Bethel, Bielefeld, Germany. 3 Department of General and Visceral Surgery, University Hospital OWL of the University Bielefeld, campus Bielefeld-Bethel, Bielefeld, Germany.…”

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confidence: 99%

“…The incidence of traumatic diaphragmatic rupture in trauma patients is about 0.5% [ 1 ]. With 80% of those cases, the left side is predominantly involved, with two-thirds of the cases subsequent to penetrating injuries and the remaining as a result of blunt trauma [ 1 , 2 ]. Up to 3% of abdominal traumas include diaphragmatic tears that bear a diagnostic challenge as they can only reliably be ruled out with direct visualization via laparo- or thoracoscopy and remain primarily undetected in 50% of cases [ 3 – 5 ].…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Fundingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…The Carter's approximately 0.5% to 1.6% of patients hospitalized for blunt trauma (3), the precise incidence of this injury seems to be likely higher than that reported by the historical series. Eighty percent of DHs are found on the left side and 20% in the right; in less than 3% of cases, DH may be bilateral (4). The incidence of DHs after a penetrating trauma is 20-59% in case of gunshot, and 15-32% in stab wounds (5).…”

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confidence: 99%

Surgical management of chronic diaphragmatic hernias

Filosso¹,

Guerrera²,

Sandri³

et al. 2019

J. Thorac. Dis

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scheme (2) recognizes: (I) acute (the acute phase is comprises between the original trauma development and the recovery of the patient); (II) latent (this phase starts from the recovery during which the patient may or may not be symptomatic), and obstructive DH [this phase starts when the intrathoracic herniated viscera become incarcerated, with potential high-risk of necrosis, ischemia and/or perforation (Figure 1)]. Although traumatic DHs have been reported in

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“…The incidence of traumatic diaphragmatic rupture in trauma patients is about 0.5%. With 80% of those cases, the left side is predominantly involved, with two thirds of the cases subsequent to penetrating injuries and the remaining as a result of blunt trauma [1,2]. Up to 3% of abdominal trauma include diaphragmatic tears that bear a diagnostic challenge as they can only reliably be ruled out with direct visualization via laparo-or thoracoscopy and remain primarily undetected in 50% of cases [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

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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Traumatic diaphragmatic injuries: a retrospective review of a 12-year experience at a tertiary trauma centre

Cited by 20 publications

References 24 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

Surgical management of chronic diaphragmatic hernias

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

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