Double traumatic diaphragmatic injury: A case report

Iadicola, D; Branca, Massimo; Lupo, Massimo; Grutta, Eugenia Maria; Mandalà, Stefano; Cocorullo, Gianfranco; Mirabella, Antonino

doi:10.1016/j.ijscr.2019.07.030

Cited by 12 publications

(15 citation statements)

References 14 publications

(39 reference statements)

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“…Some authors advocate a two-layer closure for defects greater than 2 cm, with an inner layer of interlocking horizontal mattress sutures followed by reinforcement with a running non-absorbable suture. Larger defects, (AAST grades 4-5) may require securing the diaphragm to the ribs or the use of a prosthetic mesh in order to achieve a tension-free repair [4,13,14]. In our case, the herniated colon and stomach seemed to be healthy and without perforation.…”

Section: Discussionmentioning

confidence: 68%

Traumatic Diaphragmatic Rupture with Transthoracic Organ Herniation: A Case Report and Review of Literature

et al. 2020

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Rare disease Background: Diaphragmatic rupture is a rare pathology that reported in less than 0.5% of all trauma cases, with signs and symptoms that can easily be misdiagnosed. Clinicians must maintain a high index of suspicion to correctly diagnose and manage this pathology. We present a rare case of a large diaphragmatic rupture with transthoracic gastric and colon herniation that was successfully repaired, along with a literature review. Case Report: A 59-year-old woman presented to our Trauma Center after being involved in a motor vehicle collision. She complained of chest and abdominal pain, with decreased breath sounds on the left side. CT imaging revealed discontinuity of the left hemidiaphragm, with intrathoracic herniation of stomach and colon with multiple other injuries. The patient was taken for an emergent laparotomy. The diaphragmatic rupture measured 20 cm in length, with a stellate component. After ensuring complete reduction of the herniated organs, the diaphragmatic defect was primarily repaired. The patient recovered from her injuries and was doing well at last followup in the clinic. Conclusions: This case highlights the importance of diaphragmatic rupture and its associated intra-abdominal injuries when treating trauma patients. With missed diaphragmatic injuries leading to a potential morbidity rate of 30% and mortality rate as high as 10%, the clinician must have a high index of suspicion to correctly diagnose and manage this pathology in a timely fashion. More research is needed to provide surgeons with evidence-based standardized therapies for dealing with these rare pathologies to ensure optimal patient outcomes.

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Section: Discussionmentioning

confidence: 68%

Traumatic Diaphragmatic Rupture with Transthoracic Organ Herniation: A Case Report and Review of Literature

et al. 2020

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“…Most of the traumatic diaphragmatic injuries (80-90%) occur in the left diaphragm because the left diaphragm is congenitally weaker than the right diaphragm which is protected by the liver [6]. The clinical presentation is varied as patients may be asymptomatic, may have an acute presentation as shortness of breath, shoulder pain, epigastric pain or vomiting, or may manifest at a later stage, after adhesions are formed, as intestinal obstruction, strangulation or perforation [2,7].…”

Section: Discussionmentioning

confidence: 99%

“…However, a chest radiograph may not be useful in some cases as signs are often masked by associated lung contusion, hemothorax, pneumothorax, pleural effusion, atelectasis, emphysema and non-specific elevation of diaphragm [7]. Between 20-50% of patients who are later found to have a traumatic diaphragmatic injury have their initial trauma chest radiographs described as normal [4].…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic Repair of an Acute Traumatic Diaphragmatic Hernia: Clinical Case

Costa¹,

Cardoso²,

Monteiro³

et al. 2020

Cureus

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“…In blunt trauma, a sudden rise of intraabdominal pressure can lead to diaphragmatic rupture as in our case. Left-sided ruptures are more frequent because of the protective effects of the liver (71% vs. 29%) [ 2 , 3 ]. Clinical signs and symptoms of diaphragmatic rupture after mild chest trauma are usually nonspecific and heterogenic [ 4 ], and on first admission, the diagnosis may be missed [ 2 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Faecopneumothorax Caused by Perforated Diaphragmatic Hernia

Necke

Heeren

Mongelli

et al. 2020

Case Reports in Surgery

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Incarcerated diaphragmatic hernias with intrathoracic perforation of the colon is a very rare but serious surgical emergency. A 78-year-old male patient presented to our emergency department with severe abdominal pain. A computer tomography (CT) scan revealed herniation of the left transverse colon and spleen into the thorax with colon perforation and fecal contents in the thoracic cavity. An emergent laparotomy confirmed the radiological diagnosis and showed a 6 cm dehiscence of the left diaphragm with strangulation of the left transverse colon as well as the spleen. A left-sided hemicolectomy with terminal transversostomy and splenectomy were performed. The diaphragm was closed with interrupted nonabsorbable sutures. We abstained from reinforcement of the suture line with a mesh because of the feculent contamination of the abdominal cavity. After extensive thoracoscopic lavage and insertion of two chest tubes, the patient was transferred to the intensive care unit. Diaphragmatic hernia even after a mild chest trauma can cause fatal complications. Diagnosis and treatment can be challenging and an interdisciplinary approach is recommended. Due to the associated comorbidity and long-lasting sequelae, we believe the awareness of this rare pathology as a differential diagnosis is important; both as an abdominal and thoracic emergency.

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Double traumatic diaphragmatic injury: A case report

Cited by 12 publications

References 14 publications

Traumatic Diaphragmatic Rupture with Transthoracic Organ Herniation: A Case Report and Review of Literature

Traumatic Diaphragmatic Rupture with Transthoracic Organ Herniation: A Case Report and Review of Literature

Laparoscopic Repair of an Acute Traumatic Diaphragmatic Hernia: Clinical Case

Faecopneumothorax Caused by Perforated Diaphragmatic Hernia

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