Blunt Traumatic Diaphragmatic Hernia in Children: A Systematic Review

Theodorou, Christina M.; Jackson, Jordan E.; Beres, Alana L.; Leshikar, David E.

doi:10.1016/j.jss.2021.07.011

Cited by 4 publications

(10 citation statements)

References 57 publications

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“…Traumatic diaphragmatic rupture accounts for less than 0.5% of all trauma cases and 1.9% of all blunt traumas ( 11 ). The rate of incidence of BTDR is lower in the pediatric age group, standing at 0.18% of all pediatric traumas ( 2 ). Most BTDRs occur in the left posterolateral section of the diaphragm owing to the cushion effect of the liver on the right side ( 5 , 8 ).…”

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%

“…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 ). Meanwhile, the coexistence of a pericardial rupture is very rare, with the rate of incidence ranging from 0.2% to 3.3% ( 4 ).…”

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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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“…In this study, there was no recurrence of DH after surgical repair. The recurrence of DH has been reported to be rare after surgery for traumatic DH [ 12 ]. This suggests that regardless of the approach selected, surgical repair is associated with low morbidity and mortality and excellent long-term outcomes with a low rate of recurrence.…”

Section: Discussionmentioning

confidence: 99%

Surgery for Diaphragmatic Hernia Repair: A Longitudinal Single-Institutional Experience

Lim

Cho

et al. 2023

J Chest Surg

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Background: This study analyzed and described the clinical characteristics and surgical outcomes of diaphragmatic hernia (DH) repair according to the operative approach. Methods: After excluding cases with a combined approach and hiatal hernias, we analyzed 26 patients who underwent DH repair between 1994 and 2018. The baseline and perioperative characteristics of the thoracic approach group and the abdominal approach group were described and analyzed. Results: Fifteen of the 26 patients were treated through the thoracic approach, including 5 patients who underwent video-assisted thoracic surgery (VATS). Eleven patients underwent the abdominal approach. The thoracic approach was associated with a longer duration of DH than the abdominal approach (2 vs. 0.1 months), herniation of the right-sided abdominal organs, and herniation of the retroperitoneal organs. During the median follow-up of 23 months, there was no recurrence of DH. Conclusion:The surgical approach should be chosen considering the duration of DH and the location of herniated organs. VATS might be a safe and feasible option for repairing DH.

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“…Nevertheless, ultrasound has not been routinely used in evaluating the diaphragm during the primary and secondary survey in unstable multiple trauma patients. A recent systematic review in children showed that it has a very low sensitivity of 25% (5/20) [ 66 ]. It is a tedious study and takes time and possibly it may be useful in tertiary survey when a more detailed study can be done.…”

Section: What Is the Best Way To Diagnose Dh In The Emergency Setting?mentioning

confidence: 99%

Management of complicated diaphragmatic hernia in the acute setting: a WSES position paper

et al. 2023

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Background Diaphragmatic hernia (DH) presenting acutely can be a potentially life-threatening condition. Its management continues to be debatable. Methods A bibliographic search using major databases was performed using the terms “emergency surgery” “diaphragmatic hernia,” “traumatic diaphragmatic rupture” and “congenital diaphragmatic hernia.” GRADE methodology was used to evaluate the evidence and give recommendations. Results CT scan of the chest and abdomen is the diagnostic gold standard to evaluate complicated DH. Appropriate preoperative assessment and prompt surgical intervention are important for a clinical success. Complicated DH repair is best performed via the use of biological and bioabsorbable meshes which have proven to reduce recurrence. The laparoscopic approach is the preferred technique in hemodynamically stable patients without significant comorbidities because it facilitates early diagnosis of small diaphragmatic injuries from traumatic wounds in the thoraco-abdominal area and reduces postoperative complications. Open surgery should be reserved for situations when skills and equipment for laparoscopy are not available, where exploratory laparotomy is needed, or if the patient is hemodynamically unstable. Damage Control Surgery is an option in the management of critical and unstable patients. Conclusions Complicated diaphragmatic hernia is a rare life-threatening condition. CT scan of the chest and abdomen is the gold standard for diagnosing the diaphragmatic hernia. Laparoscopic repair is the best treatment option for stable patients with complicated diaphragmatic hernias. Open repair is considered necessary in majority of unstable patients in whom Damage Control Surgery can be life-saving.

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Blunt Traumatic Diaphragmatic Hernia in Children: A Systematic Review

Cited by 4 publications

References 57 publications

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

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

Surgery for Diaphragmatic Hernia Repair: A Longitudinal Single-Institutional Experience

Management of complicated diaphragmatic hernia in the acute setting: a WSES position paper

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