Spontaneous Diaphragmatic Hernia

Darocki, M.; Medak, Anthony J.

doi:10.5811/cpcem.2018.5.38587

Cited by 4 publications

(4 citation statements)

References 12 publications

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“…Although surgical repair is the mainstay of SDH treatment, nasogastric tube intubation and decompression can relieve symptoms. This case shows that a conservative approach can be an acceptable option for patients with a prohibitive surgical risk as exemplified by this case [2,6].…”

Section: Discussionmentioning

confidence: 97%

“…The most remarkable findings on physical examination are the absence of breath sounds and the presence of bowel sounds in the thoracic cavity [6]. This patient presented both signs.…”

Section: Discussionmentioning

confidence: 99%

“…The diagnosis of SDH requires high clinical suspicion and depends on thoracic imaging. There are some red flags that should not be missed to diagnose this entity: the known presence of a previous diaphragmatic defect, dyspnea following a sudden intra-abdominal pressure increasing the maneuvre or dyspnea with vomiting [5-6].…”

Section: Discussionmentioning

confidence: 99%

“…The identification of an SDH should not be delayed because of its life-threatening potential. Early diagnosis can prevent complications, as bowel strangulation or perforation and pulmonary or vascular compression [6].…”

Section: Discussionmentioning

confidence: 99%

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Sudden Respiratory Failure after a Coughing Paroxysm

Alexandre

Pinto

2019

Cureus

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We report a case of an 85-year-old female, previously demented and dependent on others, who presented to the emergency department with sudden dyspnea following a coughing paroxysm. She was polypneic and with a diminished vesicular murmur at pulmonary auscultation but with audible bowel sounds in the right hemithorax. Arterial blood gases showed hypoxemic respiratory failure but the additional blood work was unremarkable. A thoracic radiograph suggested the presence of small bowel on the thoracic cavity. A thoracic computed tomography confirmed the diagnosis of an anterior right giant paracardiac transdiaphragmatic hernia of small bowel through the foramen of Morgagni with secondary passive pulmonary atelectasis. A posterior left transhiatal gastric hernia was also found. She was treated conservatively with nasogastric intubation and discharged home two days later, asymptomatic and without respiratory failure. Spontaneous diaphragmatic hernias are extremely rare, non-traumatic surgical emergencies, almost invariably requiring surgical correction. This case shows that a conservative approach is an alternative in selected patients.

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Section: Discussionmentioning

confidence: 97%

“…The most remarkable findings on physical examination are the absence of breath sounds and the presence of bowel sounds in the thoracic cavity [6]. This patient presented both signs.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Sudden Respiratory Failure after a Coughing Paroxysm

Alexandre

Pinto

2019

Cureus

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Woman With Abdominal Pain

Zsilinszka

Mudan

Abella

et al. 2019

Annals of Emergency Medicine

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Indolent presentation of a right-sided spontaneous diaphragmatic hernia: A case report and review of the literature

Warn,

Swisher,

Pitco

et al. 2023

International Journal of Surgery Open

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Introduction and Importance Diaphragmatic hernias are the herniation of abdominal contents through the diaphragm into the thorax and are categorized as congenital or acquired. Most commonly, acquired diaphragmatic hernia is preceded by blunt or penetrating trauma to the abdomen with the former occurring more frequently. In less than 1% of cases, acquired diaphragmatic hernias can occur spontaneously, which can be recognized incidentally on imaging or by patients presenting with non-specific symptoms. Without prompt diagnosis, patients are at risk for incarceration and strangulation of the herniated contents, resulting in bowel necrosis. Case presentation Here, we present the case of a 36-year-old male who presented with worsening 3-month history of dyspnea and palpitations. Initial clinical exam was notable for tachypnea and accessory muscle recruitment. Auscultation revealed bowel sounds in the right lung fields. Semi-upright chest radiograph uncovered a large right-sided pneumothorax containing portions of the stomach, liver, and numerous loops of bowel, with significant cardiomediastinal left shift. Surgical intervention for diaphragmatic hernia repair was promptly planned. Clinical discussion Spontaneous diaphragmatic hernia occurring secondary to a defect on the right side of the diaphragm without any history of trauma or surgery is an extraordinarily infrequent pathology. This subacute clinical presentation despite extensive anatomic involvement highlights the importance of thorough physical examination, with auscultation of bowel sounds in the thorax serving as a near pathognomonic finding for a spontaneous diaphragmatic hernia, including patients without a known history of acute trauma or previous surgery. Conclusion Surgical management of such rare hernias via abdominal, thoracic, or a combined approach coupled with pulmonary monitoring proves to be an effective treatment, and awareness of this case will aid in its identification and the ability to provide prompt intervention. Highlights

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Spontaneous Diaphragmatic Hernia

Cited by 4 publications

References 12 publications

Sudden Respiratory Failure after a Coughing Paroxysm

Sudden Respiratory Failure after a Coughing Paroxysm

Woman With Abdominal Pain

Indolent presentation of a right-sided spontaneous diaphragmatic hernia: A case report and review of the literature

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