Traumatic diaphragmatic rupture (TDR) is very rare in the pediatric age group. Because of its rarity
and its coexistence with more injuries, the diagnosis is often delayed. Very little has been written
about this condition in the pediatric age group. TDR, while uncommon, should be considered
in cases of blunt thoracic trauma. All patients should undergo meticulous examination preoperatively.
The clinical presentation and importance of making an accurate diagnosis and surgery is
highlighted. We report a case of secondary spontaneous traumatic left-sided diaphragmatic rupture
in a child that was managed by delayed surgical repair.
References
[1]
Shah, R., Sabanathan, S., Meams, A.J. and Choudhury, A.K. (1995) Traumatic Rupture of Diaphragm. The Annals of Thoracic Surgery, 60, 1444-1449. http://dx.doi.org/10.1016/0003-4975(95)00629-Y
[2]
Smithers, B.M., O’Loughlin, B. and Strong, R.W. (1991) Diagnosis of Ruptured Diaphragm Following Blunt Trauma: Results from 85 Cases. Australian and New Zealand Journal of Surgery, 61, 73741. http://dx.doi.org/10.1111/j.1445-2197.1991.tb00142.x
[3]
Sivit, C.J., Taylor, G.A. and Eichelberger, M.R. (1989) Chest Injuries in Children with Blunt Abdominal Trauma: Evaluation with CT. Radiology, 171, 815-818. http://dx.doi.org/10.1148/radiology.171.3.2717758
[4]
Keamey, P.A., Rouhana, S.W. and Burney, R.E. (1989) Blunt Rupture of the Diaphragm: Mechanism, Diagnosis and Treatment. Annals of Emergency Medicine, 18, 1326-1330. http://dx.doi.org/10.1016/S0196-0644(89)80270-7
[5]
Koplewitz, B.Z., Ramos, C., Manson, D.E., Babyn, P.S. and Ein, S.H. (2000) Traumatic Diaphragmatic Injuries in Infants and Children: Imaging Findings. Pediatric Radiology, 30, 471-479. http://dx.doi.org/10.1007/s002470000242
[6]
Shanmuganathan, K., Killeen, K., Mirvis, S.E. and White, C.S. (2000) Imaging of Diaphragmatic Injuries. Journal of Thoracic Imaging, 15, 104-111. http://dx.doi.org/10.1097/00005382-200004000-00005
[7]
Iochum, S., Ludig, T., Walter, F., Sebbag, H., Grosdidier, G. and Blum, A.G. (2002) Imaging of Diaphragmatic Injury: a Diagnostic Challenge? Radiographics, 22, S103-S116. http://dx.doi.org/10.1148/radiographics.22.suppl_1.g02oc14s103
[8]
Guth, A.A., Patcher, H.L. and Kim, U. (1995) Pitfalls in the Diagnosis of Blunt Diaphragmatic Injury. The American Journal of Surgery, 170, 5-9. http://dx.doi.org/10.1016/S0002-9610(99)80242-6
[9]
Murray, J.G., Caoili, E., Gruden, J.F., Evans, S.J., Halvorsen Jr., R.A. and Mackersie, R.C. (1996) Acute Rupture of the Diaphragm Due to Blunt Trauma: Diagnostic Sensitivity and Specificity of CT. American Journal of Roentgenology, 166, 1035-1039. http://dx.doi.org/10.2214/ajr.166.5.8615237
[10]
Martin, I., O’Rourke, N., Gotley, D. and Smithers, M. (1998) Laparoscopy in the Management of Diaphragmatic Rupture Due to Blunt Trauma. Australian and New Zealand Journal of Surgery, 68, 584-586. http://dx.doi.org/10.1111/j.1445-2197.1998.tb02105.x
[11]
Gelman, R., Mirvis, S.E. and Gens, D. (1991) Diaphragmatic Rupture Due to Blunt Trauma: Sensitivity of Plain Chest Radiographs. American Journal of Roentgenology, 156, 51-57. http://dx.doi.org/10.2214/ajr.156.1.1898570
[12]
Larici, A.R., Gotway, M.B., Litt, H.I., Reddy, G.P., Webb, W.R., Gotway, C.A., et al. (2002) Helical CT with Sagittal and Coronal Reconstructions: Accuracy for Detection of Diaphragmatic Injury. American Journal of Roentgenology, 179, 451-457. http://dx.doi.org/10.2214/ajr.179.2.1790451
[13]
Bairagi, A., Moodley, S.R., Hardcastle, T.C. and Muckart, D.J. (2010) Blunt Rupture of the Right Hemidiaphragm with Herniation of the Right Colon and Right Lobe of the Liver. Journal of Emergencies, Trauma, and Shock, 3, 70-72. http://dx.doi.org/10.4103/0974-2700.58659
