Traumatic diaphragmatic rupture in children

Burhamah, Waleed; Matcovici, Melania; Hardy, Andrewhal; Awadalla, Sami

doi:10.1016/j.epsc.2020.101619

Cited by 3 publications

(2 citation statements)

References 19 publications

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“…A traumatic diaphragmatic rupture is the loss of integrity of the diaphragm due to a sudden increase in intra-abdominal pressure from trauma ( 10 – 12 ). The most common site of rupture is at the junction of the muscle and tendon ( 3 ). Traumatic diaphragmatic rupture accounts for less than 0.5% of all trauma cases and 1.9% of all blunt traumas ( 11 ).…”

Section: Discussionmentioning

confidence: 99%

“…Diaphragmatic rupture following blunt abdominal trauma is a rare case scenario, with the rate of incidence ranging from 1% to 7% ( 1 ). Incidence is particularly low in children, with less than 1% of pediatric trauma resulting in diaphragmatic rupture ( 2 , 3 ). Since most incidences of blunt traumatic diaphragmatic rupture (BTDR) result from high-energy traumas such as motor vehicle accidents or falls from height, patients often present with severe injuries to the other visceral organs ( 2 , 4 – 7 ).…”

Section: Introductionmentioning

confidence: 99%

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Case Report: Surgical challenges and insights in a child with a blunt left diaphragmatic and pericardial rupture and heart subluxation

Kassie,

Ayana,

Abebe

et al. 2024

Front. Surg.

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IntroductionBlunt diaphragmatic rupture (BTDR) is a rare condition that can occur in children following high-energy blunt thoracoabdominal trauma. In less than 1% of the cases, pericardial rupture can coexist with a BTDR. A coexistence of BTDR and pericardial rupture can result in displacement of the heart and is associated with high mortality. Clinical presentation is non-specific and requires a high index of suspicion for early management.Case presentationA 4-year-old child presented to the emergency unit of our hospital following high-energy trauma with severe respiratory distress. Initially, a left-side chest tube was inserted, but it resulted in no clinical improvement. A chest x-ray showed a collapse of the left lung with a herniation of bowel loops into the left hemithorax. An exploratory laparotomy was done, which revealed a 10 cm × 4 cm defect in the left hemidiaphragm with a medial extension involving the pericardium. The fundus of the stomach and left lobe of the liver were displaced into the pericardial space, pushing the cardiac apex posteriorly to the right side. Concomitantly, the transverse colon and small bowel were displaced into the left pleural space. After the reduction of the herniated abdominal viscera back into the peritoneal cavity, the pericardial sac was repaired by employing an interrupted resorbable suture, while the diaphragmatic defect was repaired by using a horizontal mattress. No other injuries were identified and the abdomen was closed in layers.ConclusionBTDR with pericardial rupture is an elusive condition with a high mortality rate that necessitates a high index of clinical suspicion. Early surgical repair of the defect with a reduction of herniated organs can reduce morbidity and mortality.

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