Diaphragmatic herniation after penetrating trauma

Abstract

A study was made of 45 patients with diaphragmatic herniation after penetrating trauma. In 29 the diagnosis was established during the first admission (early presentation) and in 16 during a subsequent admission (delayed presentation). The mortality rate in the early presentation group was 3 per cent compared with 25 per cent in the delayed presentation group. The presence of gangrenous or perforated abdominal viscus in the chest cavity was the single most common and severe aggravating factor. The need for diagnosis of diaphragmatic herniation during the initial admission is emphasized. As isolated diaphragmatic injuries provide few helpful clinical features to aid diagnosis, appropriate investigations and good follow-up are of paramount importance in preventing late herniation of intra-abdominal viscera through a penetrating diaphragmatic injury.

Importance of diagnostic laparoscopy in the assessment of the diaphragm after left thoracoabdominal stab wounds: A Prospective cohort study

“…Wound in the diaphragm may enlarge over time and lead to herniation of intraabdominal organs into the thoracic cavity, causing mortality in up to 48% of cases. [2,[8][9][10]17,18] Early diagnosis and treatment is essential.…”

“…[2,9,10] In patients who undergo laparotomy due to hemodynamic instability or peritonitis, it may be easy to evaluate the diaphragm. However, such an evaluation may be challenging in asymptomatic patients who are followed conservatively.…”

Hérnia diafragmática traumática

“…O número de hérnias diafragmáticas na sua forma crônica tem aumentado, pois lesões diafragmáticas isoladas, que chegam a ocorrer em 5% a 19% dos ferimentos toracoabdominais, particularmente à esquerda, permanecem assintomáticas na ausência de sangramento ou de lesão de víscera oca 10 , diagnosticados ocasionalmente num exame radiológico do tórax ou quando ocorrem complicações, como a obstrução intestinal ou o estrangulamento de vísceras ocas herniadas 11,12 .…”

“…Os ferimentos penetrantes permanecem como a principal causa de lesões diafragmáticas despercebidas, pois tais lesões, com extensão média de 2 a 4cm, são menores do que as do trauma contuso, que variam de 5 a 15cm de extensão 2,5,7,11 . A maioria está localizada perifericamente, próximo ao sítio de entrada na parede torácica.…”

“…No caso de estrangulamento de vísceras intra-abdominais herniadas, a mortalidade aumenta dramaticamente 1,11 , podendo chegar a 88% 13 .…”