Treating traumatic injuries of the diaphragm

Abstract

Traumatic diaphragmatic injury (DI) is a unique clinical entity that is usually occult and can easily be missed. Their delayed presentation can be due to the delayed rupture of the diaphragm or delayed detection of diaphragmatic rupture, making the accurate diagnosis of DI challenging to the trauma surgeons. An emergency laparotomy and thorough exploration followed by the repair of the defect is the gold standard for the management of these cases. We report a case of blunt DI in an elderly gentleman and present a comprehensive overview for the management of traumatic injuries of the diaphragm.

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

“…The most definite finding on chest radiography was abdominal viscera in the hemithorax, as seen in two of our patients, or coiling of the nasogastric tube within the left side of the chest. (18) Other findings include the absence of fundic gas in its normal position, elevation of the hemidiaphragm and presence of a haemopneumothorax. (19) These later findings are less obvious and can potentially be misinterpreted.…”

“…This has a greater possibility of being underrecognised, with patients often showing delayed development of visceral obstruction and strangulation. (18) Chest radiography was the first-line investigation for our patients with acute diaphragmatic herniation who did not present to the ED in the arrest state. However, its efficacy in the diagnosis of TDIs was limited, as it only identified herniation in two out of nine survivors and for none of the patients who died due to the injury.…”

CT pleurogram for diagnosing an occult diaphragmatic tear

“…A missed diaphragm tear can gradually lead to herniation of bowel loops, which may end up in obstruction, strangulation or rupture and may present with life-threatening emergency 8. A high degree of suspicion is needed to diagnose an occult diaphragmatic tear.…”

“…Surgical evaluation of the diaphragm by laparotomy remains the gold standard in diagnosis 8. Even small tears need to be repaired to avoid the possibility of delayed complications.…”

Diaphragmatic rupture: Is management with biological mesh feasible?

“…Management involves repair of the diaphragmatic defect via trans-thoracic and/or trans-abdominal approaches. 2 Most small repairs may be repaired primarily, historically larger defects have been repaired with mesh. This report presents a case series of five patients with diaphragmatic injuries all repaired with biologic mesh instead of synthetic mesh.…”