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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.
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
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
Diagnosis and Surgical Treatment of Diaphragmatic Rupture Following Blunt Abdominal Traumas
Ahmet Karamercan,Osman Kurukahvecioglu,Yildirim Imren,Tonguc Utku Yilmaz,Mustafa Sare,Bulent Aytac
Surgery Journal , 2012,
Abstract: Diaphragmatic rupture observed in trauma patients with multiple organ injuries is a rare but serious problem. The incidence rate for diaphragmatic rupture is 0.8-5% while mortality rate is between 16.6-33.3%. There are cases in the literature which diaphragmatic rupture was diagnosed years after the trauma. Symptoms related to heart or lung compression due to early or delayed displacement of the abdominal viscera into the thorax or strangulation of abdominal viscera lead the physician to diagnosis. A 75-year old female patient who presented to the emergency room with shortness of breath, abdominal pain, nausea and vomiting complaints had been in a traffic accident 20 days earlier and admitted to the hospital. Abdominal ultrasound, plain radiographs and laboratory tests after the accident had been normal and the patient was discharged after a 24 h follow-up. Patient had signs of intestinal obstruction and abnormal blood gas values and posterior-anterior chest radiograph revealed elevation of the left hemidiaphragm. Thoracic computarized tomography demonstrated elevation of the posterolateral region of the left hemidiaphragm and displacement of the subdiaphragmatic organs within the thorax, up to the level of the carina. The patient had laparotomy under emergency conditions when rupture of the diaphragm was identified and repaired transabdominally. Diaphragmatic ruptures secondary to blunt traumas can be diagnosed with its early or late symptoms. Non-specific symptoms like chest pain, dyspnea, tachypnea, shortness of breath observed in patients should raise suspicion. Early or late deterioration in blood gas analyses following blunt traumas should be assessed carefully. Diagnosis can be rapidly established with direct radiographs, thoracic computarized tomography and magnetic resonance imaging. Treatment of rupture is surgery. Generally the diaphragm is repaired by the transabdominal approach while complicated ruptures can be assessed with a lower thoracic incision. Being extra vigilant following serious blunt traumas is an important factor in establishing the diagnosis.
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.
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.
Laparoscopic Treatment of a Rare Right Diaphragmatic Rupture with Small Bowel Herniation after Blunt Thoracic Trauma  [PDF]
H. Hoffmann,D. Oertli,O. Heizmann
Minimally Invasive Surgery , 2010, DOI: 10.1155/2010/109062
Abstract: Blunt traumatic diaphragmatic rupture (BTDR) is a life-threatening condition with an incidence from 0,8%–1,6% in blunt trauma, mostly located on the left side. The main prognostic factors are severe side injuries and the delay of diagnosis. We present a rare case of a 68-year-old female, with an isolated right diaphragm rupture. The diagnosis was done with a delay of 4 days by thoracic radiographs, which showed a herniation of small bowel into the right thoracic cavity. A reposition of the small bowel and a closure of the diaphragmatic defect by running suture were carried out laparoscopicly. Although large prospective studies concerning the outcome of laparoscopic approach to right BTDR are still missing, we could show, that laparoscopy can be performed safely in right traumatic diaphragm rupture. 1. Introduction Blunt traumatic diaphragmatic rupture (BTDR) is a life-threatening condition with an incidence of 0.8%–1.6% in blunt trauma [1–3]. The closure of the diaphragm rupture must be performed immediately. The diagnosis often happens to be late due to the absence of typical symptoms or other major injuries dominating the clinical aspect [4]. An isolated BTDR is rare and thus might be followed by a period of weeks or months not revealing any symptoms [2, 5]. Most BTDR are located on the left side in the musculotendinous intersection [1, 3, 4]. Right BTDR are rarely described and less frequent [6]. Herniation of colon, small bowel, or liver may occur and result in ileus, necrosis, and perforation [4, 7]. 2. Narrative We present a rare case of a 68-year-old female hospitalized in the neurological department due to Parkinson disease. She fell onto a chair hitting her right hemithorax. Initially, subjective symptoms have been missing. The examination showed a slightly reduced breath without any signs of pneumothorax or dyspnea, a decent pressure pain and a bruise. 4 days after trauma, she developed a progressive pulmonal decompensation with desaturation. Additionally, there have been signs of ileus. The chest radiograph displayed a herniation of bowel into the right hemithorax with consecutive ileus signs (Figure 1). Figure 1: Chest radiograph shows bowel herniation into right hemithorax. We performed a laparoscopic approach and found a ?cm rupture of the right diaphragm with herniation of 1 meter small bowel. The bowel appeared vital after reposition. The transdiaphragmatic thoracoscopy displayed a collapsed lung and a dislocated rib fracture (Figure 2). After irrigation of the thoracic cavity we made a direct laparoscopic strainless running suture with
Situs inversus with cholelithiasis.  [cached]
Pathak K,Khanna R,Khanna N
Journal of Postgraduate Medicine , 1995,
Abstract: Situs inversus totalis is a form of heterotaxia which is usually detected accidentally while investigating for any associated condition. If undetected, this condition can create a diagnostic puzzle. We report one such case in which situs inversus was associated with cholelithiasis.
Laparoscopic cholecystectomy in situs inversus totalis  [cached]
Hamdi Jamal,Hamdan Omar
Saudi Journal of Gastroenterology , 2008,
Abstract: Situs inversus totalis is a rare defect with genetic predisposition that may present difficulties in the diagnosis and management of abdominal pathology due to mirror-image anatomy. Occasionally, these patients may present with acute cholecystitis. Laparoscopic cholecystectomy is the standard treatment for symptomatic cholelithiasis; however, the technique has to be varied for the treatment of situs inversus totalis. To the best of our knowledge, we report the first case in Saudi Arabia of a successful laparoscopic cholecystectomy in a patient with situs inversus totalis. The technique is presented and the pitfalls are discussed with a review of the relevant literature.
Situs inversus totalis with carcinoma of gastric cardia: a case report  [cached]
Ke Pan,Dewu Zhong,Xiongying Miao,Guoqing Liu
World Journal of Surgical Oncology , 2012, DOI: 10.1186/1477-7819-10-263
Abstract: Situs inversus is an uncommon anomaly with rare incidence. Some cases of situs inversus totalis have been described with different types of associations. Here we report a case of situs inversus with carcinoma of the gastric cardia.
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