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Delayed presentation of blunt traumatic diaphragmatic hernia: A case report
AT Kidmas, D Iya, ES Isamade, E Ekedigwe
Nigerian Journal of Surgical Research , 2005,
Abstract: Blunt traumatic diaphragmatic rupture is an uncommon but severe problem that is usually seen in poly-traumatized patients. Diagnosis is often difficult resulting in delayed presentation and increased morbidity. We report a case of blunt traumatic diaphragmatic hernia in a 39-year-old man presenting 10 years after the initial abdomino-thoracic injury sustained in a road traffic accident. He had herniation of the spleen and stomach. Through a left thoracotomy, the herniated organs were reduced and diaphragmatic defect closed with interrupted nylon sutures. A high index of suspicion would minimize the morbidity and mortality associated with delayed diagnosis.
Delayed Presentation of Traumatic Diaphragmatic Hernia: a Diagnosis of Suspicion with Increased Morbidity and Mortality
Farooq Ahmad Ganie,Hafeezulla Lone,Ghulam Nabi Lone,Mohd Lateef Wani
Trauma Monthly , 2013, DOI: 10.5812/traumamon.7125
Abstract: Background: Diaphragmatic rupture due to blunt or penetrating injury may be a missed diagnosis in an acute setting and can present with a delayed complication with significantly increased morbidity and mortality.Objectives: The objective of this study is to better understand why diaphragmatic tears with delayed presentation and diagnosis are so often missed and why traumatic diaphragmatic tears are difficult to diagnose in emergency settings and how they present with grievous complications.Patients and Methods: Eleven patients with diaphragmatic hernias with delayed presentation and delayed diagnosis were operated within the last five years. All patients presented with different complications like gut gangrene or respiratory distress.Results: Out of eleven patients who were operated on for diaphragmatic hernia, three patients (27%) died. Three patients required colonic resection, one patient needed gastrectomy and one patient underwent esophagogastrectomy.Conclusions: A small diaphragmatic tear due to blunt trauma to the abdomen is difficult to diagnosis in acute settings due to ragged margins and possibly no herniated contents and usually present with a delayed complication. Therefore a careful examination of the entire traumatized area is the best approach in treating delayed presentation of traumatic diaphragmatic hernia prior to development of grievous complications.
Traumatic diaphragmatic hernia-late presentation  [cached]
Rao PLNG,Katariya R
Journal of Postgraduate Medicine , 1979,
Abstract: The traumatic diaphragmatic hernia is an established con-sequence of modern high speed transportation. Late presentation of traumatic diaphragmatic hernia is an uncommon surgical problem. Two cases of latent and obstructive traumatic diaphragmatic hernia have been presented. The clinical presentation, the diagnostic problems and the management of such cases are discussed.
Delayed Presentation of Traumatic Diaphragmatic Rupture with Herniation of the Left Kidney and Bowel Loops  [PDF]
Amiya Kumar Dwari,Abhijit Mandal,Sibes Kumar Das,Sudhansu Sarkar
Case Reports in Pulmonology , 2013, DOI: 10.1155/2013/814632
Abstract: Rupture of the diaphragm mostly occurs following major trauma. We report a case of delayed presentation of traumatic diaphragmatic hernia on the left side in a 44-year-old male who presented two weeks after a minor blunt trauma. Left kidney and intestinals coils were found to herniate through the diaphragmatic tear. This case demonstrates the importance of considering the diagnosis in all cases of blunt trauma of the trunk. It also illustrates the rare possibility of herniation of kidney through the diaphragmatic tear. 1. Introduction Traumatic diaphragmatic hernias (DH) represents only small percentage of all diaphragmatic hernias but it is no longer an uncommon entity. Injury is mostly caused by severe blunt or penetrating trauma [1]. DH may be recognized during the period of hospitalization immediately following trauma. If the diaphragmatic injury is not recognized during the immediate posttraumatic period, the patient may recover and remain symptom free or present either with chronic thoracoabdominal symptoms or with acute emergency due to intestinal strangulation [2]. During the delayed presentation with chronic thoracoabdominal symptoms, the trauma responsible for the injury is often forgotten and the diagnosis is not suspected. A careful history, physical examination, and awareness of the possibility are the prerequisite for timely diagnosis. Abdominal organs that commonly herniate are stomach, spleen, liver, mesentery, and small and large bowels. Kidney is rarely found to herniate through the diaphragmatic tear [3]. The case is unique due to occurrence of the DH with minor trauma, its delayed presentation, and herniation of the left kidney into the thorax. 2. Case Report A 44-year-old male patient was kicked in his left lower chest and upper abdomen by a neighbour during a family quarrel. Considering it to be a minor trauma, he continued his daily activities for the next two weeks. He presented to pulmonary medicine outpatient department with left sided dull aching chest pain and nonproductive cough for ten days. There was no history of abdominal pain or haematuria. On examination, he was afebrile but dyspneic (MMRC grade 2) with respiratory rate of 22 breaths/min, oxygen saturation of 96% with room air, pulse rate of 90/min, and blood pressure of 138/84?mm of Hg. On examination of the chest, there was dull note over left infraclavicular area and bowel sounds were audible over the left side of the chest. Examination of other systems was within normal limits. His chest X-ray PA view revealed a heterogeneous opacity in left lower zone but no
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
Hernia diafragmática traumática. Presentación de un caso Traumatic diaphragmatic hernia. Presentation of a case
Gilberto L Galloso Cueto,Raúl Bello Delgado,Norkis Alonso Domínguez,Ariel Jordán Alonso
Revista M??dica Electr?3nica , 2010,
Abstract: La hernia diafragmática traumática constituye un problema poco frecuente para el cirujano general, necesitándose un elevado índice de sospecha para su diagnóstico, especialmente en los pacientes portadores de un trauma cerrado. Se presenta un paciente masculino de 40 a os de edad, portador de una hernia diafragmática traumática formada por estómago y epiplón mayor, secundaria a un trauma toroco-abdominal en accidente automovilístico, en el que se práctica video toracoscopía izquierda, que permite realizar el diagnóstico correcto. Se exponen los datos clínicos del paciente, su manejo, tratamiento quirúrgico efectuado y su posterior evolución. Traumatic diaphragmatic hernia is a little frequent problem for the general surgeon, needing a high level of suspicion for the diagnosis, especially in patients carrying a closed trauma. We present the case of a male, 40-years-old patient, with a traumatic diaphragmatic hernia formed by stomach and greater omentum, secondary to a thoraco-abdominal trauma in automobile accident. A left video thoracoscopy allows arriving to the correct diagnosis. We expose the clinical data of the patient, his management, the surgical treatment applied and his subsequent evolution.
Presentación tardía de hernia diafragmática traumática con necrosis gástrica: revisión de la literatura científica Delayed presentation of diaphragmatic hernia with gastric necrosis: literature review
Marcelo A Beltrán
Revista Colombiana de Cirugía , 2013,
Abstract: La hernia diafragmática complicada de presentación tardía constituye una urgencia quirúrgica debido a la isquemia y eventual necrosis y gangrena de los órganos herniados. Los órganos o estructuras que se encuentran con mayor riesgo de sufrir complicaciones por la hernia son el colon, el estómago, el bazo, el epiplón mayor y los intestinos. La necrosis y gangrena del estómago se deben a su estrangulamiento dentro de la hernia, lo que constituye una complicación grave y potencialmente mortal. El presente artículo resume brevemente la literatura científica relevante sobre el diagnóstico clínico y radiológico, y el tratamiento de la necrosis gástrica como complicación de la hernia diafragmática de presentación tardía. Complicated diaphragmatic hernia with delayed presentation constitutes a surgical emergency due to ischemia and eventual necrosis and gangrene of the herniated organs. The organs or structures at greater risk of complications are colon, stomach, spleen, greater omentum, and small bowel. Gastric necrosis and gangrene are secondary to the twisting and strangulation of the stomach inside the hernia sac, constituting a severe and potentially lethal complication. This article reviews and briefly resumes the current relevant literature on the clinical and radiological diagnosis and the treatment of gastric necrosis as complication of diaphragmatic hernia with delayed presentation.
Post Traumatic Diaphragmatic Hernia Revealing a Colonic Tumor  [PDF]
Mohammed Elkehal, Sani Rabiou, Boubacar Efared, Saad Slaiki, Hicham Elbouhadouti, Yassine Ouadnouni, Nawal Hammas, Taoufiq Harmouch, Mohamed Smahi
Open Journal of Thoracic Surgery (OJTS) , 2016, DOI: 10.4236/ojts.2016.63003
Abstract: Post traumatic diaphragmatic injuries have long been known. However their varied clinical, expressions lead to difficulties which cause its delay. The occurrence of herniation of hollow viscera in the thoracic cavity followed by its necrosis or perforation, is a delayed complication, a rare entity with a poor prognosis. The discovery of a colonic tumor in a diaphragmatic hernia is an exceptional clinical circumstance. Here we report the case of a patient with a complicated diaphragmatic hernia, whose symptoms are precipitated by the presence of a colon stenosing tumor. The management consisted of an exclusive laparotomy had allowed dealing in one surgical intervention with both the abdominal and thoracic injuries.
Mechanical Bowel Obstruction as a Late Presentation of Traumatic Diaphragmatic Hernia Oclusión intestinal mecánica como presentación tardía de una hernia diafragmática postraumática  [cached]
Igor Hernández Toboso,Jacinto Navas Igarza,Rolando Rodríguez Delgado
MediSur , 2012,
Abstract: Traumatic diaphragmatic hernia is a rare entity that occurs only in 0.3 to 1, 6% of all abdominal trauma, being blunt or penetrating. It is sometimes lately diagnosed. The case of a 35 years old male patient with a history of 5 cm stab wound in the lower back of the left hemithorax 5 years before admission is presented. He attended medical care for colic abdominal pain and signs of intestinal obstruction without previous abdominal surgical history. The patient underwent surgery and a left diaphragmatic hernia in left complicated location was found. The patient presented a favorable outcome. La hernia diafragmática postraumática es una entidad poco frecuente que se presenta solo en el 0,3 al 1, 6 % de todos los traumas abdominales, cerrados o penetrantes. En ocasiones se diagnostica tardíamente. Se presenta el caso de un paciente masculino de 35 a os, con antecedentes de herida por arma blanca de 5 cm en la base posterior del hemitórax izquierdo 5 a os antes del ingreso, que acude por dolor abdominal de tipo cólico y signos de oclusión intestinal, sin antecedentes quirúrgicos abdominales anteriores. Se intervino quirúrgicamente y se encontró hernia diafragmática de localización izquierda complicada. Tuvo una evolución favorable.
Traumatic diaphragmatic hernia: case report  [cached]
Miguel Angel Serra Valdés,Mario Achon Polhamus,Maria de Lourdes Menéndez Villa,Liudmila Carnesoltas Suarez
Medwave , 2013,
Abstract: Introduction. Traumatic diaphragmatic hernias occur after blunt or penetrating trauma. The case reported in this article is an incidental and unusual diagnosis in clinical practice. Case. We report a woman with a history of thoraco-abdominal trauma from a road accident that occurred 30 years ago. In the chest X-ray we found a radioopacity in the right lung base resulting from a respiratory infection. The image persisted in spite of effective treatment for the underlying respiratory condition, which made us suspect a diaphragmatic hernia corroborated by computed tomography. Discussion. A high level of suspicion is essential for the initial evaluation of patients with blunt or penetrating thoraco-abdominal trauma. Conclusions. Traumatic diaphragmatic hernias constitute a clinical challenge both for diagnosis and surgical treatment.
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