Traumatic diaphragmatic hernia: errors in diagnosis

Ball, Thomas P.; McCrory, R; Smith, Jo; Clements, Jr Jl

doi:10.2214/ajr.138.4.633

Cited by 64 publications

(16 citation statements)

References 7 publications

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“…Traumatic diaphragmatic rupture (TDR) occurs in approximately 5% of patients with major blunt thoracoabdominal trauma, most of them on the left side and an early correct diagnosis is made in less than 50% of cases [3][4][5]. The difficulty of the diagnosis and the high mortality and morbidity rates of the untreated cases make this clinical entity more important [6].…”

Section: Introductionmentioning

confidence: 99%

Traumatic diaphragmatic rupture: look to see

Turhan

Makay

Çakan

et al. 2008

European Journal of Cardio-Thoracic Surgery

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Objective: Traumatic diaphragmatic rupture (TDR) is a rare but potentially life threatening clinical entity with a high incidence of associated injuries. In this article, our experience with this challenging diagnosis is presented. Methods: In this study, a total of 68 patients with TDR, were operated in our center between July 1994 and September 2005. Study group was analyzed retrospectively. The etiological factors, management and outcomes were discussed. Results: The mean age was 32.9 years with a female to male ratio of 9/59. TDR was right-sided in 16.2% (n = 11) and left-sided in 83.8% (n = 57). The cause of the rupture was penetrating trauma in 51 (75%), and blunt trauma in 17 (25%). Only three patients (4.4%) had late diagnosis. Associated injuries were seen in 91% (n = 62) of the patients. The most common used incision was a laparotomy incision (89.6%). Morbidity and mortality were encountered in 13.1% (n = 9) and 16.2% (n = 11) patients, respectively. Conclusions: Although rare, diaphragmatic rupture must be suspected in any patient with thoracoabdominal injury. Early diagnosis of TDR is sometimes difficult and depends on a high index of suspicion. Surgical repair is necessary even for small tears. The most common approach is the transabdominal approach, which allows a complete exploration of the abdominal organs for associated injuries. The transthoracic approach might be used in most cases with latent diaphragmatic rupture. #

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Section: Introductionmentioning

confidence: 99%

Traumatic diaphragmatic rupture: look to see

Turhan

Makay

Çakan

et al. 2008

European Journal of Cardio-Thoracic Surgery

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“…If the hernia is suspected, an appropriate barium study should be performed. There are a number of case reports in the literature where late presenting diaphragmatic hernias have been misdiagnosed as pneumothorax and patients have undergone unnecessary emergency thoracocentesis (4,6). Although the clinical presentation in our case was not suggestive about any disease, it was misdiagnosed as bronchiectasia according to chest X-ray.…”

Section: Discussionmentioning

confidence: 62%

An Unusual Cause of Maternal Respiratory Distress in Postoperative-Postpartum Period: Diaphragmatic Hernia

et al. 2012

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“…Males usually outnumber females [1] and only around 13% of the hernias are found on the right side [3]. To diagnose traumatic diaphragmatic hernia a high index of suspicion is required in patients with a history of trauma and herniated structures may be seen with radiological investigations such as chest radiographs, barium meal and barium enema studies [4]. CT scan has now been regarded as the diagnostic radiological tool of choice [5].…”

Section: Discussionmentioning

confidence: 99%

Post-Traumatic Diaphragmatic Hernia

Hajong

Baruah

2012

Indian J Surg

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Post-traumatic diaphragmatic hernia is not an uncommon sequel. But lack of awareness of this condition may delay in diagnosis and result in life-threatening complications. CT scan is regarded as the investigative tool of choice but some prefer Barium studies in delayed cases of diaphragmatic hernia. Chest X-ray and Ultrasonography of the chest and abdomen may also help in arriving at a diagnosis. An awareness of the condition assisted by the radiological investigations will lead to an early diagnosis and treatment which ultimately helps in managing the patients with diaphragmatic hernias better. Keywords Diaphragmatic hernia . Trauma . Radiological investigationsA 30 year old male patient was admitted with h/o severe pain upper abdomen for 3 days which started following lifting of a heavy weight. No associated vomiting or fever. Patient gives history of stab injury left side of the chest wall 3 years back from which the patient had uneventful recovery. On examination the patient had labored and fast breathing, pulse rate of 130/m, B.P. 110/76 mmHg. CXR showed an overtly elevated left hemi-diaphragm (Fig. 1). CT scan abdomen and thorax showed stomach and omentum herniating into the chest (Fig. 2). A diagnosis of diaphragmatic hernia was made. On operation most of the stomach along with greater omentum was found herniated into the chest through a small diaphragmatic defect on the left hemidiaphragm and was almost gangrenous. The hernia defect was closed with non-absorbable suture. A near-total gastrectomy was performed and a Roux-en -Y end to side gastrojejonostomy was done. DiscussionInjuries to the diaphragm may be followed by immediate herniation of abdominal viscera into the chest. However it is widely accepted that herniation may be delayed [1,2]. Males usually outnumber females [1] and only around

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Traumatic diaphragmatic hernia: errors in diagnosis

Cited by 64 publications

References 7 publications

Traumatic diaphragmatic rupture: look to see

Traumatic diaphragmatic rupture: look to see

An Unusual Cause of Maternal Respiratory Distress in Postoperative-Postpartum Period: Diaphragmatic Hernia

Post-Traumatic Diaphragmatic Hernia

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