Traumatic right diaphragmatic hernia in children: Diagnostic difficulties

Abstract

Traumatic right diaphragmatic hernia is rare in children. Its diagnosis can be difficult in the acute phase of trauma because its signs are not specific, especially in a poly trauma context. We report two cases of traumatic right diaphragmatic hernia following a blunt thoraco-abdominal trauma, highlighting some difficulties in establishing an early diagnosis and the need for a high index of suspicion.

Blunt Traumatic Diaphragmatic Hernia in Children: A Systematic Review

“…However, three of these cases were diagnosed on repeat CT scans at 7 d, 6 mo, and 7 mo post-injury respectively, with initially normal CT scans. 17 , 31 For two other cases the CT scans were not done in the initial trauma evaluation; one on post injury d seven, 32 and the other postoperatively after damage control laparotomy for hemorrhage control. 33 26 Thus, the sensitivity of the initial CT scan for detecting TDH was 65.8% (25 of 38).…”

“…Notably, two of the hepatic injuries involved inadvertent chest tube placement into the herniated liver. 32 There were eight patients with vascular injuries (14.0%), in-cluding two aortic injuries, 21 four inferior vena cava (IVC) injuries, 21 , 22 , 44 and three hepatic vein injuries. 8 , 22 Gastric injury was reported in eight patients; 8-10 , 16 , 19 , 21 notably, of these, three were due to iatrogenic placement of chest tubes into the herniated stomach.…”

Incidental traumatic right diaphragmatic rupture: a missed case after trauma

“…ultrasonography might be helpful in detecting the functional status of the diaphragm and the presence of intraabdominal organs in the thoracic cavity [10].…”