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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.
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.
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.
Late presentation of congenital diaphragmatic Hernia after a diagnostic laparoscopic surgery (a case report)  [cached]
Yap Kok Hooi,Jones Mark
Journal of Cardiothoracic Surgery , 2013, DOI: 10.1186/1749-8090-8-8
Abstract: The authors report a rare case of 17-year-old lady with late presentation of congenital diaphragmatic hernia. She presented with vague abdominal pain and was thought to have urinary tract infection, ruptured ovarian cyst, and appendicitis by different medical teams in the first few days. She eventually underwent a diagnostic laparoscopy with no significant findings. In the early postoperative recovery period, she suffered from severe cardiorespiratory distress and a large intestinal left diaphragmatic hernia was diagnosed subsequently. At further operation a strangulated loop of large bowel herniating through a left antero-lateral congenital diaphragmatic hernia was discovered, which was reduced and repaired with a prolene mesh through thoracotomy. She made an excellent recovery and was discharged a few days after the operation. The authors postulate a mechanism of positive pressure from laparoscopic surgery causing herniation of large bowel through a pre-existing diaphragmatic defect. This case highlights the diagnostic challenge of this disease due to its diverse clinical presentation, the importance of prompt diagnosis and intervention.
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.
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
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.
Hernia diafragmática congénita: Reporte de un caso de presentación tardía Congenital diaphragmatic hernia: report of a case with a late presentation
Alejandro álvarez J,Fernando Bravo V,Claudia Bello C,Rodrigo Baier Ch
Revista chilena de pediatría , 2004,
Abstract: La Hernia Diafragmática Congénita (HDC) es un defecto simple del diafragma de etiología desconocida, con una incidencia de 1 por cada 2 200 a 2 400 nacidos vivos. Se presenta generalmente como un cuadro de distress respiratorio en el periodo neonatal con morbimortalidad importante, debido a grados variables de hipoplasia e hipertensión pulmonar. Los casos de presentación tardía oscilan entre 5 a 25% y se asocian a mejor pronóstico. Presentamos el caso de una lactante de 5 meses de edad a quien se le diagnostica una HDC derecha mediante radiografía de tórax y se revisa la patogenia, tratamiento y pronóstico de la enfermedad Congenital diaphragmatic hernia (CDH) is a simple defect of the diaphragm of unknown aetiology, with an incidence of 1 in 2,200 to 2,400 births. It presents most frequently in the newborn period, with respiratory distress and is an important cause of newborn morbi-mortality by causing variable degrees of pulmonary hypoplasia and hypertension. Late presenting cases represent between 5% and 25% of all cases and have a better prognosis. We present the case of a 5 month child with a right sided CDH diagnosed by a chest x-ray, we discuss the pathogenesis, treatment and prognosis. In conclusion when CDH is diagnosed later in life the prognosis is better and the results of surgery excellent
Late complication of diaphragmatic injury: Hernia- a report of 4 cases and review of literature
S. Ozdemir,E. S. Ozi?,K. Gulpinar,D. Karadag
Annals of Gastroenterology , 2009,
Abstract: Diaphragmatic injuries mostly occur as a result of high-speed motor vehicle accidents and to less extent after penetrating or non-traumatic causes from the abdomen. Since they are frequently symptom-free it is difficult for clinicians to diagnose. As a consequence, abdominal viscera herniation towards the thoracic cavity, mainly to the left side, may lead both to respiratory insufficiency as well as to the serious late complication of strangulation of the protruded visceral organ. We presented herein four cases of diaphragmatic hernia as a late complication after traumatic diaphragmatic injury; three having a history of blunt thoracic trauma and one after a penetrating injury to the upper abdomen. Diagnostic procedures and treatment are discussed.
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