Blunt Traumatic Hernia of Diaphragm With Late Presentation

Abstract

BackgroundDiaphragmatic hernia after blunt trauma is an uncommon and often undiagnosed condition.ObjectivesWe aimed to review patients who presented with delayed blunt traumatic hernia of diaphragm.Patients and MethodsIn this retrospective study, the medical records of six patients treated for blunt diaphragmatic hernias who were admitted to Kashan Shahid Beheshti hospital between June 2007 and June 2011 were analyzed.ResultsSix patients with mean age of 41 years were included in the study. Male to female ratio was 2:1. Mean duration between trauma and admission to the hospital was 6.5 years (2 – 26 years). Five patients had left-sided diaphragmatic hernia. Chest X-ray was obtained from all patients which was diagnostic in 50 percent of the cases (n = 4). Additional diagnostic imaging with computerized tomography (CT) was used in six patients and upper gastrointestinal (GI) contrast study was performed in one patient. All patients underwent thoracotomy incision. Mesh repair was utilized in one patient. The mean hospitalization time was 14.1 days. There was one postoperative death (16.7%).ConclusionsLate presentation of blunt diaphragmatic hernia is an uncommon and challenging situation for the surgeon. Prompt diagnosis and treatment prevent serious morbidity and mortality associated with complications such as gangrene and perforation of herniated organ.

Does a Negative Emergency Celiotomy Exclude the Possibility of Significant Diaphragmatic Injury? A Case Report and Review of the Literature

“…Exploratory laparotomy/thoracotomy and thoracoscopic/laparascopic evaluation with meticulous examination of both hemi-diaphragms are the gold standard for diaphragmatic evaluation following blunt and or penetrating trauma. Presentation/diagnosis of the DR (blunt traumatic diaphragmatic hernia) can be delayed for long periods (between 2-26 years in some reports) ( 8 ). Even with a thorough evaluation (DDDR is always a possibility), delayed DR may form following the initial exploration.…”

Delayed Presentation of Diaphragmatic Rupture: An Unusual Case of Dyspnea

“…A thoracotomy is preferred for all right-sided diaphragmatic defects, regardless of the timing of initial injury. 17,18 Teaching Points…”

Delayed Presentation of Posttraumatic Diaphragmatic Hernia Masquerading as Recurrent Acute Asthmatic Attack

“…Blunt traumatic rupture of the diaphragm is a serious injury that is often difficult to diagnose [ 1 ]. As many as 30% of diaphragmatic hernias present late [ 2 ].…”

“…As many as 30% of diaphragmatic hernias present late [ 2 ]. The incidence is rising due to increasing surgeons experience and surgical subspecialization in our subregion [ 1 ]. Ambroise Paré in 1579 described the first case of diaphragmatic rupture in a French artillery captain who initially survived a gunshot wound of the abdomen but died 8 months later of a strangulated gangrenous colon, herniating through a small diaphragmatic defect that would admit only the tip of a small finger [ 3 ].…”