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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
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.
Delayed diagnosis of a right-sided traumatic diaphragmatic rupture  [cached]
Alexandr Ku?era,Michal Rygl,Ji?í ?najdauf,Lucie Kavalcová
Clinics and Practice , 2012, DOI: 10.4081/cp.2012.e3
Abstract: Right-sided traumatic diaphragmatic rupture in childhood is a very rare injury. Diaphragmatic rupture often manifests itself later, after an organ progressively herniates into the pleural cavity. When the patient is tubed, the ventilation pressure does not allow herniation of an organ, which occurs when the patient is ex-tubed. We present a patient with a delayed diagnose of right sided diaphragmatic rupture with a complicated post-operation state.
Delayed presentation of a traumatic diaphragmatic hernia  [cached]
Chi-Tun Tang,Ming-Ying Liu,Chi-Tun Tang
Signa Vitae , 2011,
Abstract: Delayed presentation of a traumatic diaphragmatic hernia is an infrequent condition with a high mortality and morbidity rate. This case describes a 26-year-old man presenting with a 2-day history of cramping abdominal pain, dyspnea, nausea, and vomiting. The patient reported a penetrating thoracic injury one year prior to the development of clinical signs. Computed tomography revealed the presence of empyema or parapneumonic effusion of the left hemithorax. Based on the clinical history and physical findings, a diaphragmatic hernia was considered and an emergency laparotomy with segmental resection of strangulated jejunum and reduction of remaining bowel was performed. A 1.5 cm tendinous defect was identified and repaired. The patient recovered and was discharged uneventfully.Conclusion: the early recognition of a delayed diaphragmatic hernia contributed to the uneventful recovery of this critically ill patient.
Bilateraly Diaphragmatic Traumatic Rupture with Delayed and Liver Herniation of Right Diaphragmatic Rupture  [PDF]
Hatice ?ztürkmen Akay,Refik ülkü
Dicle Medical Journal , 2004,
Abstract: Bilateraly diyafragmatic rupture is a rare pathology. The incidence isregarded 0.8-5%. Here we reported a bilateraly diyafragmatic rupture withdelayed right diyafragmatic liver herniation. We review the literature andwe mentioned the important radiologic findings of the patology withultrasonoghraphy, Computed tomography, and magnetic resonanceimaging.
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.
Delayed Presentation of Traumatic Intraperitoneal Rupture of Urinary Bladder  [PDF]
Hazim H. Alhamzawi,Husham M. Abdelrahman,Khalid M. Abdelrahman,Ayman El-Menyar,Hassan Al-Thani,Rifat Latifi
Case Reports in Urology , 2012, DOI: 10.1155/2012/430746
Abstract: Blunt injury of the urinary bladder is well known and usually associates pelvic fractures. Isolated bladder injury is a rare condition and on the other hand, delayed bladder perforation is an extremely rare entity. Herein, we described an unusual case of isolated delayed intraperitoneal bladder rupture that occurred on the third post injury day in a young male in the absence of free intraperitoneal fluid and pelvic fracture. The diagnostic workup, course and the need for surgical repair of the injury is presented. 1. Introduction Around 60% to 85% of all bladder injuries result from blunt abdominal trauma (BAT) but the incidence of intraperitoneal urinary bladder (UB) rupture is relatively uncommon from blunt injuries [1]. Isolated UB rupture following blunt trauma has an insidious presentation, and often results in delayed diagnosis and management [2–8]. The mechanism of injury include sudden compression of the full bladder, shear forces, or a pelvic fracture [2, 3, 9]. Rupture of bladder may be presented with lower abdominal pain, inability to void, and perineal ecchymoses [3]. The cardinal sign of injury to the bladder is gross hematuria [6], which is present in more than 95% of cases, while only about 5% of the patients have microscopic hematuria alone [6, 7]. Over 80% of the patients with UB rupture had an associated pelvic fracture in centers with high percentage of blunt trauma. On the other hand around 6% of patients with pelvic fracture sustain a bladder injury [3, 6]. Diagnosis of bladder injury, several days after admission, could be either a missed diagnosis or a truly delayed rupture. Delayed diagnosis of bladder rupture may be associated with laboratory abnormalities such as metabolic derangements, and leukocytosis. Delay in the presentation and treatment may substantially increases mortality [7–10]. Therefore, early and accurate diagnosis with imaging techniques is imperative. Computed tomographic cystography (CTC) and/or retrograde cystography (RGC) are the standard imaging tools for the diagnosis of bladder injury [4–10]. We present a case of delayed rupture of UB due to blunt trauma without associated injuries. 2. Case Report A twenty three-year old male patient sustained BAT due to fall from a 3-meter height. Initial vital signs were: blood pressure136/80?mmHg, heart rate 64?BPM, respiratory rate 20 per minute, oxygen saturation of 100% on room air, and temperature of 36.9°C. Patient was fully conscious with neither external bleeding nor neurological deficits. Abdominal examination showed mild generalized tenderness and voluntary
Diaphragmatic rupture causing repeated vomiting in a combined abdominal and head injury patient: a case report and review of the literature
Dimitrios Symeonidis, Michail Spyridakis, Georgios Koukoulis, Grigorios Christodoulidis, Ioannis Mamaloudis, Konstantinos Tepetes
World Journal of Emergency Surgery , 2012, DOI: 10.1186/1749-7922-7-20
Abstract: We present a challenging case of a young male with combined abdominal and head trauma. Repeated episodes of vomiting dominated on clinical presentation that in the presence of a deep scalp laceration and facial bruising shifted differential diagnosis towards a traumatic brain injury. However, a computed tomography scan of the brain ruled out any intracranial pathology. Finally, a more meticulous investigation with additional imaging studies confirmed the presence of diaphragmatic rupture that justified the clinical symptoms.The combination of diaphragmatic rupture with head injury creates a challenging trauma scenario. Increased level of suspicion is essential in order to diagnose timely diaphragmatic rupture in multiple trauma patients.
Incarcerated Gastro-thorax: a rare and delayed presentation of diaphragmatic injury due to multiple stab wounds.
Sanoop Zachariah,Parag Dhamne,Nirmalan Raja
Journal of Surgical Case Reports , 2010,
Abstract: Diaphragmatic injuries due to thoraco-abdominal penetrating trauma may often go unnoticed at the initial admission, especially in patients who are asymptomatic, with stable hemodynamic and respiratory parameters. Such occult diaphragmatic perforations can result in latent morbidity and mortality due to delayed trans-diaphragmatic herniation of the abdominal viscera leading to incarceration, strangulation and perforation. Here we report a case of an initially asymptomatic patient who had sustained multiple truncal stab injuries and presented two months later with a trans-thoracic incarceration of the stomach which was accurately diagnosed and successfully repaired at the time of surgery .This case report highlights the importance of exploring thoraco-abdominal penetrating injuries even in the absence initial clinical and radiological signs, so as to promptly identify occult and isolated diaphragmatic perforations and prevent delayed catastrophes. The clinical features, radiological findings, diagnostic difficulties and surgical options are discussed along with review of relevant literature.
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