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Blunt traumatic diaphragmatic rupture Rotura diafragmática no trauma abdominal fechado  [cached]
Antonio Carlos Nogueira,Munir Bazzi,Francisco Garcia Soriano,Haydée Jord?o
Autopsy and Case Reports , 2011,
Abstract: Traumatic injury of the diaphragm ranges from 0.6 to 1.2% and rise up to 5% among patients who were victims of blunt trauma and underwent laparotomy. Clinical suspicion associated with radiological assessment contributes to early diagnosis. Isolated diaphragmatic injury has a good prognosis. Generally worse outcomes are associated with other trauma injuries. Bilateral and right diaphragmatic lesions have worse prognosis. Multi detector computed tomography (MDCT) scan of the chest and abdomen provides better diagnostic accuracy using the possibility of image multiplanar reconstruction. Surgical repair via laparotomy and/ or thoracotomy in the acute phase of the injury has a better outcome and avoids chronic complications of diaphragmatic hernia. The authors present the case of a young male patient, victim of blunt abdominal trauma due to motor vehicle accident with rupture of the diaphragm, spleen and kidney injuries. The diagnosis was made by computed tomography of the thorax and abdomen and was confirmed during laparotomy. A incidência de les o traumática do diafragma, relatada na literatura, varia de 0,6 a 1,2% dentre os pacientes vítimas de traumas, elevando-se para 5% nos pacientes com trauma fechado submetidos a laparotomia. A suspeita clínica associada à avalia o radiológica contribui para o diagnóstico precoce. A les o diafragmática isoladamente é de bom prognóstico. Assim, em geral, as les es associadas à rotura diafragmática s o os preditores da pior evolu o do paciente. As les es do diafragma direito e as les es bilaterais apresentam pior prognóstico. A tomografia computadorizada com multidetectores (MDCT) de tórax oferece a possibilidade de reconstru o multiplanar permitindo melhor acurácia no diagnóstico. A corre o cirúrgica por meio de laparotomia e/ou toracotomia na fase aguda do trauma apresenta boa evolu o e evita as complica es cr nicas da hérnia diafragmática. Os autores apresentam o caso de um paciente jovem do sexo masculino, vítima de trauma abdominal fechado por acidente automobilístico que apresentou rotura do diafragma, les o esplênica e renal. O diagnóstico foi feito através da tomografia computadorizada de tórax e abdome e confirmada durante laparotomia exploradora.
A review on delayed presentation of diaphragmatic rupture
Farhan Rashid, Mallicka M Chakrabarty, Rajeev Singh, Syed Y Iftikhar
World Journal of Emergency Surgery , 2009, DOI: 10.1186/1749-7922-4-32
Abstract: A Pubmed search was conducted using the terms "delayed presentation of post traumatic diaphragmatic rupture" and "delayed diaphragmatic rupture". Although quite a few articles were cited, the details of presentation, investigations and treatment discussed in each of these were not identical, accounting for the variation in the data presented below.Late presentation of diaphragmatic rupture is often a result of herniation of abdominal contents into the thorax[1]. Sudden increase in the intra abdominal pressure may cause a diaphragmatic tear and visceral herniation[2]. The incidence of diaphragmatic ruptures after thoraco-abdominal traumas is 0.8–5% [3] and up to 30% diaphragmatic hernias present late[4]. Diaphragmatic, lumbar and extra-thoracic hernias are well described complications of blunt trauma [5]. Incorrect interpretation of the x ray or only intermittent hernial symptoms are frequent reasons for incorrect diagnosis[6].Diaphragmatic rupture with abdominal organ herniation was first described by Sennertus in 1541[7,8]. Diaphragmatic injury is a recognised consequence of high velocity blunt and penetrating trauma to the abdomen and chest rather than from a trivial fall[8]. These patients usually have multi system injuries because of the large force required to rupture the diaphragm[9].Blunt trauma to the abdomen increases the transdiaphragmatic pressure gradient between the abdominal compartment and the thorax[10]. This causes shearing of a stretched membrane and avulsion of the diaphragm from its points of attachments due to sudden increase in intra abdominal pressure, transmitted through the viscera[11]. Delay in presentation of a diaphragmatic hernia could be explained by various different hypotheses. Delayed rupture of a devitalised diaphragmatic muscle may occur several days after the initial injury [8]. This is best exemplified in the case report of bilateral diaphragmatic rupture [12], where the left diaphragmatic rupture was identified 24 hours after th
Diaphragmatic rupture with right colon and small intestine herniation after blunt trauma: a case report
Mirko Muroni, Giuseppe Provenza, Stefano Conte, Andrea Sagnotta, Niccolò Petrucciani, Ivan Gentili, Tatiana Di Cesare, Andrea Kazemi, Luigi Masoni, Vincenzo Ziparo
Journal of Medical Case Reports , 2010, DOI: 10.1186/1752-1947-4-289
Abstract: We report a case of a 59-year-old Italian man hospitalized for abdominal pain and vomiting. His medical history included a blunt trauma seven years previously. A chest X-ray showed right diaphragm elevation, and computed tomography revealed that the greater omentum, a portion of the colon and the small intestine had been transposed in the hemithorax through a diaphragm rupture. The patient underwent laparotomy, at which time the colon and small intestine were reduced back into the abdomen and the diaphragm was repaired.This was a unusual case of traumatic right-sided diaphragmatic hernia. Diaphragmatic ruptures may be revealed many years after the initial trauma. The suspicion of diaphragmatic rupture in a patient with multiple traumas contributes to early diagnosis. Surgical repair remains the only curative treatment for diaphragmatic hernias. Prosthetic patches may be a good solution when the diaphragmatic defect is severe and too large for primary closure, whereas primary repair remains the gold standard for the closure of small to moderate sized diaphragmatic defects.Traumatic rupture of the diaphragm is an uncommon condition. It occurs in 0.8 to 5% of patients admitted to hospital with thoracoabdominal trauma. The etiologic factors are blunt trauma (for example, in motor vehicle accidents) and penetrating trauma [1]. The organs most commonly involved in right-sided diaphragmatic hernias are the colon, omentum, small intestines and liver.Chest radiography and computerized tomography is the most effective method for diagnosis of traumatic diaphragmatic rupture [2]. Treatment is surgical, with reduction of the viscera and simple repair of the diaphragm with non-absorbable suture.A 59-year-old Italian man presented with abdominal pain localized in the right upper quadrant, constipation and vomiting for longer than one week. The patient had inconstant symptoms including shortness of breath and dyspnea. His medical history included right-sided rib fractures in a moto
Asymptomatic diaphragmatic rupture with retroperitoneal opening as a result of blunt trauma  [cached]
Narci Adnan,Sen Tolga,Koken Resit
Journal of Emergencies, Trauma and Shock , 2010,
Abstract: Blunt traumas of the abdomen and thorax are important clinical problems in pediatric ages. Severity of trauma may not always be compatible with the patients′ clinical situation. A 2-year-old male child was admitted to our emergency clinic as a result of tractor crash accident. Physical examination of the child was normal. The abdominal and thoracic ultrasonography (USG) examination performed in the emergency clinic was normal. In thoracic computed tomography (CT) scan of the patient, there was irregularity of the right diaphragmatic contour that was described as micro perforation-rupture (the free air was just in the perihepatic and retroperitoneal area, which was not passing through the abdomen). The patient was followed-up for 1 week in the hospital with a diagnosis of retroperitoneal diaphragmatic rupture. It is not appropriate to decide the severity of trauma in childhood on the basis of clinical findings. Although severe trauma and sustaining radiological examinations, the patients′ clinical pictures may be surprisingly normal, as in our patient. In such cases, there may not be any clinical symptom. CT scan examination must be preferred to USG for both primary diagnosis and follow-up of these patients. According to the current literature, there is no reported case with retroperitoneal rupture of the diaphragm.
Isolated Blunt Traumatic Diaphragmatic Rupture in a Case of Situs Inversus  [PDF]
Raiees Ahmad, Malik Suhail, Alfer Nafae, Qayoom Khan, Pervaze Salam, Shahnawaz Bashir, Yawar Nisar
Surgical Science (SS) , 2015, DOI: 10.4236/ss.2015.63021
Abstract:

Situs inversus, a very rare congenital anomaly of reversal site of thoracic and abdominal organs, can be very problematic to surgeon while dealing with a case of trauma in emergency. Surgical procedures are considered difficult, complex and more challenging in patients with this condition due to the anatomical difference and position of organs. We came across an interesting and very rare case of isolated blunt traumatic diaphragmatic injury in a case of situs inversus. Traumatic injuries of the diaphragm are uncommon and isolated blunt traumatic injuries of diaphragm are very rare. Our case is very unique of its kind of situs inversus with isolated right sided diaphragmatic rupture in a 60-year-old male patient presenting 4 hours after blunt trauma to chest and abdomen.

Late Onset Traumatic Rupture of the Diaphragm with a Minor Blunt Trauma: A Case Report  [cached]
Nazik A??l?o?lu,Atay ?zkal,Burak Tander
Journal of Academic Emergency Medicine , 2011,
Abstract: Rupture of the diaphragm after blunt trauma is uncommon in children but it is usually associated with life-threatening complications. A delay in diagnosis may result in an increased mortality and morbidity. A case of a ten month old girl with diaphragmatic rupture and gastric herniation presenting one month after a minor blunt trauma is reported in this article Diagnosis of isolated diaphragmatic rupture is difficult during the preoperative period. Following blunt or penetrating traumas, this possibility should be considered in order to diagnose diaphragmatic ruptures.
Isolated duodenal rupture due to blunt abdominal trauma  [cached]
Celik Atilla,Altinli Ediz,Onur Ender,Sumer Aziz
Indian Journal of Critical Care Medicine , 2006,
Abstract: Duodenal rupture following blunt abdominal trauma is rare and it usually seen with other abdominal organ injuries. It represents approximately 2% to 20% of patients with blunt abdominal injury and often occurs after blows to the upper abdomen, or abdominal compression from high-riding seat belts. Two cases of blunt duodenal rupture successfully treated surgically, are presented with their preoperative diagnosis and final out comes.
Simple Blunt Trauma and Diaphragmatic Rupture Showing Delayed Clinical Signs  [cached]
Tar?k Ocak,Ramazan Ku?aslan,Mustafa Ba?türk,Hakan Yi?itba?
Akademik Acil T?p Olgu Sunumlar? Dergisi (AKATOS) , 2012,
Abstract: The diaphragm provides the progression between certain structures and the chest cavity by means of an anatomic hiatus. The diaphragm is the second most functional muscle structure of the body after the heart. Diaphragm injuries may result from serious blunt or penetrating injuries. While most of the blunt diaphragm infuries are caused by traffic accidents and falls from heights, some may occur as a result of other blunt traumas to the lower chest or epigastrium. Diaphragm injuries may be seen in t 0.8-1.6% of the patients hospitalized due to blunt abdominal trauma. In this study, we will report that a diaphagm injury of a patient who has a history of blunt abdominal trauma was diagnosed six months after the trauma when he was admitted to hospital because of stomach ache and pain in his left chest.
Right-sided diaphragmatic rupture after blunt trauma. An unusual entity
Ramon Vilallonga, Vicente Pastor, Laura Alvarez, Ramon Charco, Manel Armengol, Salvador Navarro
World Journal of Emergency Surgery , 2011, DOI: 10.1186/1749-7922-6-3
Abstract: Traumatic injuries of the diaphragm remain an entity of difficult diagnosis despite having been recognised early in the history of surgery. Sennertus, in 1541, performed an autopsy in one patient who had died from herniation and strangulation of the colon through a diaphragmatic gap secondary to a gunshot wound received seven months earlier [1]. However, these cases remain rare, and difficult to diagnose and care for. This has highlighted some of the aspects related to these lesions, especially when they are caused by blunt trauma and injuries of the right diaphragm [1,2].We report the case of a man of 36 years of age, thrown from a height of 12 meters and was referred to our centre. The patient arrived conscious and oriented, and we began manoeuvring the management of the patient with multiple injuries according to the guidelines of the ATLS (Advanced Trauma Life Support) recommended by the American College of Surgeons. The patient had an unstable pelvic fracture (type B2) with hemodynamic instability and respiratory failure. Patient's Injury Severity Score (ISS) was 38. Pelvis and chest X-rays were performed which confirmed the pelvic fracture and pathological elevation of the right hemidiaphragm was observed (Figure 1). We proceeded to stabilise the pelvic fracture and replace fluids, improving hemodynamic status. The patient continued with respiratory failure. For this reason, a chest tube was placed and Computerised Tomography (CT) was performed (Figure 2), showing a ruptured right hemidiaphragm, including chest drain in the right hepatic lobe and occupation of the lesser sac by blood. The patient underwent surgery, finding a right hemidiaphragm transverse rupture with a hepatothorax and an intrahepatic thoracic tube. We performed the suture of the diaphragm and liver packing, moved the patient to the intensive care unit, and after 48 hours, the liver packing was removed without problems. The patient evolved favourably.Currently, traumatic injuries of the diaph
Intraperitoneal Rupture of Hepatic Hydatid Cyst Following Blunt Abdominal Trauma  [cached]
Anjan Kumar Dhua,Akshay Sharma,Yogesh Kumar Sarin
APSP Journal of Case Reports , 2012,
Abstract: Peritonitis due to rupture of liver hydatid cyst secondary to blunt abdominal trauma can present with fatal consequences. Timely diagnosis and appropriate surgical management can be life saving. We report a case of ruptured liver hydatid cyst in the peritoneal cavity following trauma and its successful operative management in a preadolescent previously asymptomatic boy. Importance of detailed physical examination and early diagnosis by using appropriate radiological investigations is highlighted.
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