Traumatic right diaphragmatic rupture with hepatothorax in Ghana: two rare cases

Okyere, Isaac; Okyere, Perditer; Glover, Paul Sedem Komla

doi:10.11604/pamj.2019.33.256.17061

Cited by 8 publications

(10 citation statements)

References 7 publications

(23 reference statements)

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“…In case of complications, surgery is mandatory [23]. Smaller diaphragmatic defects can be primarily closed with a non‐absorbable suture [28, 29] while for larger defects, where the primary suture would develop excessive tension due to the considerable loss of tissue, or also in order to reinforce the suture, meshes should be used [30, 31]. The biologic mesh represents an alternative to the synthetic one due to its lower rate of hernia recurrence, higher resistance to infections and lower risk of displacement [23, 32, 33].…”

Section: Discussionmentioning

confidence: 99%

Complicated Diaphragmatic Hernia in Emergency Surgery: Systematic Review of the Literature

et al. 2020

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Introduction Complicated diaphragmatic hernia (DH) can be congenital or acquired. Congenital diaphragmatic hernias (CDH) are rare and often can be asymptomatic until adulthood. Traumatic diaphragmatic hernia (TDH) is a complication that occurs in about 1–5% of victims of road accidents and in 10–15% of penetrating traumas of the lower chest. CDH and TDH are potentially life‐threatening conditions, and the management in emergency setting still debated. This study aims to evaluate the surgical treatment options in emergency setting. Methods A bibliographic research reporting the item “emergency surgery” linked with “traumatic diaphragmatic rupture” and “congenital diaphragmatic hernia” was performed. Several parameters were recorded including sex, age, etiology, diagnosis, treatment, site and herniated organs. Results The research included 146 articles, and 1542 patients were analyzed. Most of the complicated diaphragmatic hernias occurred for a diaphragmatic defect due to trauma, only 7.2% occurred for a congenital diaphragmatic defect. The main diagnostic method used was chest X‐ray and CT scan. Laparotomic approach still remains predominant compared to the minimally invasive approach. Conclusion Surgery is the treatment of choice and is strongly influenced by the preoperative setting, performed mainly with X‐ray and CT scan. Minimally invasive approach is safe and feasible but is highly dependent on the surgeon's expertise, especially in emergency setting.

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Section: Discussionmentioning

confidence: 99%

Complicated Diaphragmatic Hernia in Emergency Surgery: Systematic Review of the Literature

et al. 2020

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“…The diaphragmatic defect is usually closed by simple suture, with nonabsorbable sutures for minor defects [ 33 , 34 ]. Any hiatal defect that is larger than 5 cm 2 (the hiatal hernia area (HSA)) has a formal recommendation for reinforcement—if the edges of the defect can be sutured—with either mesh or replacement if aggrandizement is not possible ( Figure 5 ).…”

Section: Resultsmentioning

confidence: 99%

Rare Diaphragmatic Hernias in Adults—Experience of a Tertiary Center in Esophageal Surgery and Narrative Review of the Literature

Predescu,

Achim,

Socea

et al. 2023

Diagnostics

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A rare entity of non-hiatal type transdiaphragmatic hernias, which must be clearly differentiated from paraoesophageal hernias, are the phrenic defects that bear the generic name of congenital hernias—Bochdalek hernia and Larey-Morgagni hernia, respectively. The etiological substrate is relatively simple: the presence of preformed anatomical openings, which either do or do not enable transit from the thoracic region to the abdominal region or, most often, vice versa, from the abdomen to the thorax, of various visceral elements (spleen, liver, stomach, colon, pancreas, etc.). Apart from the congenital origin, a somewhat rarer group is described, representing about 1–7% of the total: an acquired variant of the traumatic type, frequently through a contusive type mechanism, which produces diaphragmatic strains/ruptures. Apparently, the symptomatology is heterogeneous, being dependent on the location of the hernia, the dimensions of the defect, which abdominal viscera is involved through the hernial opening, its degree of migration, and whether there are volvulation/ischemia/obstruction phenomena. Often, its clinical appearance is modest, mainly incidental discoveries, the majority being digestive manifestations. Severe digestive complications such as strangulation, volvus, and perforation are rare and are accompanied by severe shock, suddenly appearing after several non-specific digestive prodromes. Diagnosis combines imaging evaluations (plain radiology, contrast, CT) with endoscopic ones. Surgical treatment is recommended regardless of the side on which the diaphragmatic defect is located or the secondary symptoms due to potential complications. The approach options are thoracic, abdominal or combined thoracoabdominal approach, and classic or minimally invasive. Most often, selection of the type of approach should be made taking into account two elements: the size of the defect, assessed by CT, and the presence of major complications. Any hiatal defect that is larger than 5 cm2 (the hiatal hernia surface (HSA)) has a formal recommendation of mesh reinforcement. The recurrence rate is not negligible, and statistical data show that the period of the first postoperative year is prime for recurrence, being directly proportional to the size of the defect. As a result, in patients who were required to use mesh, the recurrence rate is somewhere between 27 and 41% (!), while for cases with primary suture, i.e., with a modest diaphragmatic defect, this is approx. 4%.

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“…Five patients had no intrathoracic viscus/organ herniation. Auscultation of bowel sounds in the lower lung zones with dull percussion note may also be suggestive of a possible diaphragmatic rupture with bowel herniation [ 7 , 10 , 13 ]. The preoperative diagnosis of most of our patients was of clinical suspicion, with the most common imaging done being chest X-ray.…”

Section: Discussionmentioning

confidence: 99%

“…Commonly implicated associated injuries include shock, respiratory distress and coma [ 3 ]. It has been reported that up to two-thirds of patients with TDR and associated multisystem injuries have had initial diagnosis of the rupture missed, and this accounts for the drastic rise in mortality and morbidity rates [ 13 ]. At least 62% of patients with associated injuries have been documented to have had diagnosis of diaphragmatic rupture missed up until the 4 th day [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…In Ghana, comprehensive data on diaphragmatic rupture are scanty. The only data available are two publications by Okyere et al , with one on right diaphragmatic rupture associated with hepatothorax and the other on left diaphragmatic rupture with herniated intrathoracic gastric perforation [ 13 , 14 ]. Therefore, this study was aimed at evaluating the surgical management of traumatic diaphragmatic rupture in our institution over a ten-year period looking at the surgical approach and repair technique per the specialty that managed the case and the general outcome of the patients.…”

Section: Introductionmentioning

confidence: 99%

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Surgical management of traumatic diaphragmatic rupture: ten-year experience in a Teaching Hospital in Ghana

Okyere¹,

Mensah²,

Singh³

et al. 2022

kitp

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Introduction Diaphragmatic injuries may be associated with thoracoabdominal blunt or penetrating traumas. The diagnosis is often delayed, despite the availability of several medical imaging modalities. The surgical management remains controversial, in terms of the choice of surgical approach and the surgical repair technique. Aim To evaluate the surgical management experience of traumatic diaphragmatic rupture in our institution over a ten-year period in the local setting of a tertiary hospital in Ghana. Material and methods A retrospective review of the medical records of patients who had undergone surgery for traumatic diaphragmatic rupture. Results A total of 35 cases of diaphragmatic rupture were seen from thoracoabdominal injuries. There were 29 (82.86%) males. The mean age was 36.25 ±12.98 years with a range of 16–65 years. There were 3 cases of right diaphragmatic rupture and 32 cases of left diaphragmatic rupture. Penetrating chest injury caused 18 (51%) of the ruptures. The leading cause of injury was road traffic accident, which constituted 48.57%, closely followed by stab (25.71%), gunshot injuries (14.29%) and impalement injury (11.48%). Seventeen (49%) patients had their diaphragmatic ruptures repaired via laparotomy and the remaining 18 (51%) via thoracotomy. The commonest herniated organ was the stomach. One patient died in theatre from cardiac arrest after failed intubation. Conclusions Surgery is the treatment of choice in traumatic diaphragmatic rupture and it is repaired via laparotomy or thoracotomy based on the presence or absence of concomitant abdominal injury and the presence or absence of a cardiothoracic surgeon.

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Traumatic right diaphragmatic rupture with hepatothorax in Ghana: two rare cases

Cited by 8 publications

References 7 publications

Complicated Diaphragmatic Hernia in Emergency Surgery: Systematic Review of the Literature

Complicated Diaphragmatic Hernia in Emergency Surgery: Systematic Review of the Literature

Rare Diaphragmatic Hernias in Adults—Experience of a Tertiary Center in Esophageal Surgery and Narrative Review of the Literature

Surgical management of traumatic diaphragmatic rupture: ten-year experience in a Teaching Hospital in Ghana

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