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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
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.
Secondary Spontaneous Rupture of the Diaphragm in a Child after Blunt Chest Trauma  [PDF]
Seydou Togo, Bourama Kané, Moussa Abdoulaye Ouattara, Issa Boubacar Maiga, Yunping Lu, Donghui Jin, Allaye Ombotimbé, Ibrahim Sangaré, Maiga Abdoul Aziz, Cheik Amed Sekou Touré, Ibrahim Coulibaly, Adama Issa Koné, Sitan Illiassou, Jaques Saye, Cheik Sadibou Traoré, Sékou Koumaré, Moussa Camara, Koita Adama Kononba, Mody Traoré, Zimogo Zié Sanogo, Sadio Yéna, Djibril Sangaré
Open Journal of Respiratory Diseases (OJRD) , 2016, DOI: 10.4236/ojrd.2016.62006
Abstract: 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.
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
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.
Strangulated Tension Viscerothorax with Gangrene of the Stomach in Missed Traumatic Diaphragmatic Rupture  [PDF]
Uvie Onakpoya,Akinwumi Ogunrombi,Anthony Adenekan,William Akerele
ISRN Surgery , 2011, DOI: 10.5402/2011/458390
Abstract: Acquired diaphragmatic hernias are usually posttraumatic in occurrence. In patients who have blunt trauma and associated diaphragmatic hernia, the diagnosis may be missed or delayed, often leading to poor treatment outcomes. We present a rare occurrence of tension viscerothorax due to missed traumatic diaphragmatic rupture in a 25-year-old woman whose condition was complicated by gangrene and perforation of the fundus as well as questionable viability of the anterior wall of the body of the stomach. The patient had a successful emergency transabdominal suture plication of the diaphragm and gastroplasty and has remained symptomless 3 months postoperatively. 1. Introduction Acquired diaphragmatic hernias are usually posttraumatic in occurrence. They occur following motor vehicular accidents, falls, and stabs or after laparoscopic upper abdominal surgeries [1]. Though penetrating chest and abdominal injuries have higher chances of causing diaphragmatic hernias, it is well known that blunt trauma is associated with the condition. The diagnosis of a diaphragmatic rent is often made in patients who suffer penetrating abdominal injuries because they have higher incidences of operative intervention and as such, the diagnosis is usually made intraoperatively. However, in patients who have diaphragmatic hernia due to blunt trauma, the diagnosis may be missed or delayed, leading to poor outcomes [2, 3]. Tension viscerothorax occurring as a result of a traumatic diaphragmatic hernia is very rare [4]. We present a case of tension viscerothorax occurring in patient with missed traumatic diaphragmatic rupture whose condition was complicated by gangrene and perforation of the fundus and questionable viability of the anterior wall of the body of the stomach. 2. Case Report A 25-year-old lady was referred from a medical facility in 2010 where she had previously been managed for 8 weeks for a left shoulder avulsion injury and blunt chest trauma sustained during a motor vehicular accident. She had a successful skin grafting and was considered for discharge home a day before she was referred to us when she suddenly developed difficulty with breathing, dull aching central chest pain, and palpitations. She was referred on intravenous dopamine support due to a cardiovascular collapse and was immediately admitted into the intensive care unit (ICU) of the Obafemi Awolowo University Teaching Hospital. Examination revealed a profusely sweaty young woman who was pale, dehydrated, and in severe respiratory distress (respiratory rate, 58 cycles/min) despite being on intranasal oxygen
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.

Traumatic diaphragmatic rupture with delayed gastric incarceration  [cached]
Wani Nisar,Kosar Tasleem,Ahmad Asrar,Yusuf Mohammad
Journal of Emergencies, Trauma and Shock , 2010,
Abstract:
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.
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