Missed Diaphragmatic Injuries and Their Long-Term Sequelae

Reber, P. U.; Schmied, Bruno M.; Seiler, Christian; Baer, H. U.; Patel, Amit; Mw, Büchler

doi:10.1097/00005373-199801000-00026

Cited by 191 publications

(174 citation statements)

References 31 publications

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“…[9] The literature about the management of delayed diaphragmatic hernia consists mainly of sporadic cases and very few well-documented but limited case series. [7,10,11] Since these case series are more than a decade old, the use of sophisticated diagnostic modalities such as multislice computerized tomography (CT) and magnetic resonance imaging (MRI) in delayed presentation has not been evaluated. Moreover, with the progress in postoperative patient care, morbidity and mortality have been improved.…”

Section: Resultsmentioning

confidence: 99%

Delayed presentation of posttraumatic diaphragmatic hernia

Okan¹,

Baş²,

Ziyade³

et al. 2011

Ulus Travma Acil Cerrahi Derg

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Section: Resultsmentioning

confidence: 99%

Delayed presentation of posttraumatic diaphragmatic hernia

Okan¹,

Baş²,

Ziyade³

et al. 2011

Ulus Travma Acil Cerrahi Derg

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“…Sennertus was the first to describe a traumatic diaphragmatic hernia in 1541 [4,12]. Bowditch made an antemortem diagnosis of a traumatic diaphragmatic rupture in 1853 [13].…”

Section: Discussionmentioning

confidence: 99%

“…In conservatively managed patients, the rate of initially missed diaphragmatic injuries ranges from 12 to 66%, and they may even be overlooked at laparotomy [4,5]. Diagnosis of a diaphragmatic injury requires a high index of suspicion, as delayed diagnosis increases the chance of visceral herniation and strangulation, which has mortality as high as 60% [6].…”

Section: Introductionmentioning

confidence: 99%

Computed Tomography in the Evaluation of Diaphragmatic Hernia following Blunt Trauma

2012

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Diagnosis of traumatic diaphragmatic hernia due to blunt abdominal trauma requires a high index of suspicion. This study was conducted to assess the accuracy of multidetector computed tomogram (MDCT) in the diagnosis of traumatic diaphragmatic hernia. All patients with thoracoabdominal blunt trauma with diaphragmatic hernia diagnosed on radiologic evaluation during a 3-year period (i.e., from June 2004 to June 2007) were analyzed. Nineteen patients with diaphragmatic injuries in 117 patients with blunt thoracoabdominal injury (16.23%) were studied. Age range was 8-60 years (mean 34 years). Male-female ratio was 18:1. Various features seen on CT scan were diaphragmatic discontinuity in 13 (68.42%), thickened diaphragm in 10 (52.63%), "collar sign" in 8 (42.10%), visceral herniation in 12 (63.15%), dependent viscera sign in 8 (42.10%), and segmental nonrecognition of the diaphragm in 1 patient (5.88%). Two patients presented with delayed rupture. In the rest mean duration between time of injury and performance of CT scan was 44.35 h (range 3-288 h). Fourteen patients underwent operative management. Sensitivity, specificity, and accuracy of MDCT scan were 100, 93, and 95%, respectively. Three patients (15.78%) expired. MDCT is a highly accurate modality for detecting traumatic diaphragmatic hernia.

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“…Diagnostic accuracy of preoperative chest x-ray for TDI was 27-60 % for left-sided injuries and 17 % of right-sided injuries [15]. The diagnostic accuracy of chest radiographs is variable and could range from 27 to 62 % for left-sided diaphragm and 3 to 17 % for right-sided diaphragm [16]. From our study, chest roentgen had good specificity (100 %), poor negative predictive value (15.8 %), and poor diagnostic accuracy 9/43 (20.9 % confidence interval, 10.04 to 36.04 %).…”

Section: Discussionmentioning

confidence: 99%

Traumatic Diaphragmatic Injury: A Marker of Serious Injury Challenging Trauma Surgeons

et al. 2013

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The objectives of this study are (1) to evaluate prevalence of traumatic diaphragmatic injury (TDI), (2) identify the predictors of mortality, and (3) study the accuracy of investigations in survivors of TDI. Retrospective analysis of prospectively maintained database of TDI from January 2007 to December 2011. Emergency department (ED) records, operative details, and autopsy reports were reviewed to determine injury characteristics, treatment provided, and outcome. Statistical analyses were performed using the SPSS ver.15 software. TDI was identified in 75 individuals. Thirty-two of 75 (42.6 %) cases were brought dead to the hospital, and 43/75 (57.3 %) were survivors presented to emergency department, diagnosed to have TDI intraoperatively. Seven of 43 (16.3 %) died postoperatively. Mortality in TDI was significantly related to age (p =0.001), injury severity (p <0.001), site of TDI (p =0.002), and associated injuries (p =0.021, odds ratio of 9). Death increased with increase in the number of organ injured (p <0.001, odds ratio of 12). Multi-detector computer tomography (MDCT) detected TDI in 23/26 (88.5 %) cases preoperatively. Laparotomy (p <0.001, odds ratio of 22) and thoracotomy (p =0.021, with odds ratio of 9) were associated with survival benefit when compared to minimal invasive surgery in injured cases. The prevalence of TDI was 2.67 %, TDI's mark severity of injury. Mortality increases with increasing number of organ injured. Right-sided or bilateral injury of diaphragm is associated with increased mortality.

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Missed Diaphragmatic Injuries and Their Long-Term Sequelae

Abstract: Initial recognition and treatment of diaphragmatic rupture or injury is important in avoiding long-term sequelae.

Cited by 191 publications

References 31 publications

Delayed presentation of posttraumatic diaphragmatic hernia

Delayed presentation of posttraumatic diaphragmatic hernia

Computed Tomography in the Evaluation of Diaphragmatic Hernia following Blunt Trauma

Traumatic Diaphragmatic Injury: A Marker of Serious Injury Challenging Trauma Surgeons

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