Complications of diaphragmatic hernia jama surgery jama. This case demonstrates the importance of considering the diagnosis in all. When hemorrhagic shock combining with openwound on chest wall, thoracic. Delayed presentation of traumatic diaphragmatic hernia. A case of tension faecopneumothorax after delayed diagnosis of. Diaphragmatic hernia usually is secondary to trauma but can occur as a congenital anomaly. Delayed presentation of traumatic diaphragmatic hernia a 10yearold boy presented with abdominal pain around the umbilicus since 8 hours, 4 episodes of nonbilious vomiting and pain in the left shoulder since 5 hours. Traumatic diaphragmatic injuries from blunt or penetrating trauma are difficult. Diaphragmatic injury is uncommon, representing less than 1 percent of all traumatic injuries. Left kidney and intestinals coils were found to herniate through the diaphragmatic tear. Diagnosisdiagnosis hiatal hernia,hiatal hernia, paraesophagealparaesophageal typetype 4. Left congenital diaphragmatic hernia case report l.
Many of these infants have associated congenital defects which increase the morbidity and mortality. Ct scan is regarded as the investigative tool of choice but some prefer barium studies in delayed cases of diaphragmatic hernia. The aetiology of congenital diaphragmatic hernia is unclear,although2%isfamilial and 15% of patients have chromosomal abnormalities. The disorder results in lung hypoplasia, pulmonary hypertension and severe hypoxia. As in infants, most diaphragmatic hernias in adults 85% occur on the left 4.
The patient was referred to our emergency room suffering from ileus symptoms. Traumatic diaphragm injuries tdi pose both diagnostic and therapeutic challenges in both the acute. Respiratory compromise, although not always evident, is common in. The first traumatic diaphragmatic hernia was reported by sennertus in 1541. Delayed diagnosis of traumatic diaphragmatic hernia may.
The diaphragm is usually injured in association with other thoracic and abdominal organs. This is a photo of a peritoneopericardial diaphragmatic hernia in a cat. Early diagnosis of traumatic diaphragmatic hernia is necessary to decrease morbidity and mortality associated with it. Traumatic herniation of abdominal contents through a tear or rupture of the central or posterior aspect of the hemidiaphragm may follow blunt thoracoabdominal trauma. Diaphragmatic rupture can result from blunt or penetrating trauma and occurs in about 5% of cases of severe blunt trauma to the trunk. Congenital diaphragmatic hernia cdh is a birth defect that occurs when a babys diaphragm doesnt form correctly during fetal development, typically around 9 to 10 weeks gestation. The overall incidence of diaphragmatic rupture after blunt trauma is 0. We report the case of a patient with blunt trauma with right diaphragmatic rupture that required urgent surgical treatment for hepatothorax and iatrogenic severe liver injury.
Complications of diaphragmatic hernia jama surgery. Experimental evidence suggests that pulmonary hypoplasia is the primary defect in congenital diaphragmatic hernia. This leaves an opening between the chest and abdominal cavities, allowing abdominal organs to herniate protrude or enter into the chest cavity and. Diaphragmatic rupture often results from blunt abdominal trauma. Congenital diaphragmatic hernia suny downstate medical. Laparoscopic repair of post traumatic diaphragmatic hernia. Traumatic diaphragmatic herniaour experience sciencedirect. A 6yearold boy presented to the hospital after several hours of vomiting and dyspnea. There was no history of fever or bowel disturbances. The clinical manifestations of true and false hernias are similar, but their anatomical differences necessitate their differentiation. Diaphragmatic rupture also called diaphragmatic injury or tear is a tear of the diaphragm, the muscle across the bottom of the ribcage that plays a crucial role in respiration. The prognosis for survival after diaphragmatic hernia in dogs is good, with mortality rates ranging from 14% to 28%. Failure of normal closure of the pleuroperitoneal canal in the developing embryo. Survival 6070% cause is unknown failure of normal closu.
Herniation of abdominal organs is present in 34% of people with abdominal trauma who present to a trauma center. Congenital diaphragmatic hernia incidence 1 in 2000 to 5000 live births. The lungs are hypoplastic and have abnormal vessels that cause respiratory insufficiency and persistent pulmonary. Ct scan is regarded as the investigative tool of choice but some prefer barium studies in. Therefore, after an anatomic defect is corrected, periodic assessments of pulmonary function and chest radiography are important see the image below. Early diagnosis and management of traumatic diaphragmatic hernia tdhcan be challenging for the emergency. More than 90% of blunt traumatic diaphragmatic ruptures result from motor vehicle accidents, as was the case in this patient. Traumatic diaphragmatic hernia is a rare and often under. Nguyen hong linh, f, 19nguyen hong linh, f, 19months, a16months, a16dx. We report a case of delayed presentation of traumatic diaphragmatic hernia on the left side in a 44yearold male who presented two weeks after a minor blunt trauma. Surgery on the abdomen or chest may also cause accidental damage to your diaphragm.
Thoracotomy compared to laparotomy in the traumatic. A magnetic resonance imaging mri scan was done when the diagnosis of ruptured right dome of diaphragm with traumatic diaphragmatic hernia tdh with herniation of liver into the right hemithorax. Bochdalek and morgagni hernias, along with diaphragmatic eventration, typically originate in utero from developmental weaknesses or defects in the diaphragm acquired. Diaphragmatic hernia an overview sciencedirect topics.
A 31yearold man who sustained blunt traumas by traffic accident was seen at the hospital because of lumbago. Penetrating injuries are usually due to stab or gunshot wounds. Recurrence is possible after traumatic herniation or a congenital diaphragmatic hernia that was repaired in an adult. While barium studies remain vital in assessing diaphragmatic hernias pre and postoperatively, plain. Rightsided defects are less common because closure of the right. Case recurrent diaphragmatic hernia 3 years after initial. Most commonly, acquired diaphragmatic tears result from physical trauma.
Dec 17, 2018 recurrence is possible after traumatic herniation or a congenital diaphragmatic hernia that was repaired in an adult. Closure of the right hemidiaphragm occurs before the left, which may account for the higher incidence of left sided diaphragmatic defects 84%. Nontraumatic diaphragmatic hernia in adult sushila ladumor1and adham darweesh2 1consultant radiologist, clinical imaging department, hamad medical corporation, hgh, doha, qatar, assistant professor in clinical radiology, weil cornel medical college, qatar wcmcq. Delayed diagnosis of traumatic diaphragmatic hernia may cause. Among numerous retrospective studies, increase in injury severity score appears most frequently with statistical significance.
It can lead to rupture of abdominal organs into the chest cavity. Evaluation and management of traumatic diaphragmatic injuries. Pdf laparoscopic repair of traumatic diaphragmatic. In 21 72% patients the diagnosis was made within 24hrs and in 828% patients the diagnosis was made after 24hrs. Post traumatic diaphragmatic hernia is not an uncommon sequel.
The photo was taken during necropsy from the right side of the cat. Diaphragmatic rupture leads to a traumatic diaphragmatic hernia 1. Traumatic injuries of the diaphragm remain an entity of difficult diagnosis despite having been recognised early in the history of surgery, especially when it comes to blunt trauma and injuries of the right diaphragm. A traumatic right diaphragmatic rupture as the result of blunt trauma is a rare condition. Traumatic diaphragmatic hernia is a rare and often under recognized complication of penetrating and blunt trauma. Epidemiology given that the most common mechanism is motor vehicle collisions, it is perhaps unsurprising that youn. Pdf traumatic diaphragmatic rupture tdr needs early diagnosis and operation. But lack of awareness of this condition may delay in diagnosis and result in lifethreatening complications. Traumatic diaphragmatic hernias tdhs are uncommon, but lifethreatening, and remain a diagnostic and therapeutic challenge with an overall mortality rate of up to 31% in recent series. Traumatic diaphragmatic rupture with combined thoracoabdominal. We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail.
Traumatic diaphragmatic hernia jama surgery jama network. Traumatic diaphragmatic hernia has always been a diagnostic challenge to both the radiologist and surgeon. A significant complication of diaphragmatic rupture is traumatic diaphragmatic herniation. It is generally considered to be a marker of severe trauma. In 14, acute hernias were diagnosed, but the diagnosis was made one month to 15 years after injury in 22 patients with chronic hernia. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis.
Rupture of the diaphragm mostly occurs following major trauma. Delayed presentation of traumatic rightsided diaphragmatic. Article traumatic diaphragmatic hernia applied radiology. Thank you for your interest in spreading the word about the bmj. To date, only about 100 such cases of leftsided and 10 such cases of rightsided diaphragmatic hernia have been reported 9,10.
Computed tomography demonstrated a diaphragmatic hernia. Pdf traumatic diaphragmatic hernia challenging diagnosis and. Early identification and diagnosis remains a challenge. Traumatic diaphragmatic hernia is an uncommon, underdiagnosed, and potentially lifethreatening condition with a documented incidence of 6% in cases of blunt trauma. The cause of rupture was blunt trauma in 2483% patients and penetrating trauma in 517% patients. A traumatic diaphragmatic hernia is caused as a result from blunt or penetrating trauma and occurs in about 5% of cases of severe blunt trauma to the trunk. Congenital diaphragmatic hernia cdh is defined by the presence of an orifice in the diaphragm, more often left and posterolateral that permits the herniation of abdominal contents into the thorax.
The mechanism of diaphragmatic tear with blunt trauma is described and modes of diagnosis and treatment are discussed. Bochdalek and morgagni hernias, along with diaphragmatic eventration, typically originate in utero from developmental weaknesses or defects in the diaphragm. Traumatic diaphragmatic hernia is an uncommon but important problem in the patient with multiple injuries. Mar 06, 2012 post traumatic diaphragmatic hernia is not an uncommon sequel. After antenatal diagnosis, cases should be referred to a regional centre for ongoing antenatal.
In cases of trauma, rib fractures, pulmonary contusions, traumatic myocarditis, hemothorax, and shock are also often present concurrently with diaphragmatic hernia. Traumatic diaphragmatic hernias, when diagnosed many years after the traumatic event, are observed in about 10% of diaphragmatic injuries. Diaphragmatic hernia thorsang chayovan chaiyapongse tangsittitum pgy2 radiology 2. The mechanism of injury is typically a motorvehicle collision. Delayed presentation of traumatic diaphragmatic rupture. Barium enema traumatic diaphragmatic hernia of colon chronic traumatic disruption of the left hemidiaphragm plain chest radiograph of diaphragmatic injury with herniation chest radiograph with rupture of the left hemidiaphragm traumatic diaphragmatic hernia on computed tomography diaphragmatic injury with left hemidiaphragm discontinuity traumatic disruption of the diaphragm on. The incidence of blunt traumatic diaphragm hernia in patients undergoing surgical exploration ranges.
Any information contained in this pdf file is automatically generated from digital material submitted to. To the left is the abdomen, where part of the liver and the gall bladder can be seen. The traumatic diaphragmatic hernia diagnosis is based. Respiratory distress can be caused by any one or a combination of these lesions. Sanitorium and rajiv gandhi institute of chest diseases, bangalore, india between january 1998 and.
Due to coexisting injuries and the silent nature of diaphragmatic injuries, the diagnosis is easily missed or difficult. Hernia of the diaphragm, however, may produce serious complications associated with considerable morbidity and possible fatality. Jan 18, 2011 traumatic injuries of the diaphragm remain an entity of difficult diagnosis despite having been recognised early in the history of surgery, especially when it comes to blunt trauma and injuries of the right diaphragm. A total of 14 patients were thus identified 12 males and 2 females. Rightsided diaphragmatic rupture after blunt trauma. Descriptions of recurrent diaphragmatic hernia, especially after repair of traumatic rupture, have been. Traffic accidents and falls cause the majority of blunt injuries. Acquired diaphragmatic hernias stem from all types of trauma, with blunt forces accounting for the majority. Patients with traumatic diaphragmatic hernias often had a history of penetrating or blunt trauma.
This type of hernia usually is repaired by placing a soft plastic mesh over the hole the hernia, and stapling this mesh to the surrounding diaphragm edge. Traumatic diaphragmatic hernia occurs in less than 50% of the patients with diaphragmatic injuries. During development, two membranes merge to close the open area between the chest and the abdomen. Multiple imaging modalities are available to evaluate the diaphragm following trauma. Road traffic accidents were the most common cause, accounting for the majority of cases 12 patients.
This paper describes the case of a 32yearold man who experienced a traffic accident and had diagnosis of traumatic diaphragmatic hernia nearly four months later. Twenty nine patients underwent surgery for traumatic diaphragmatic hernia. We report our experience with a delayed traumatic rightsided diaphragmatic hernia presenting with large bowel incarceration two months after abdominoplasty. Pathophysiology of traumatic diaphragmatic herniaassociated respiratory compromise. Seven acute tdhs were due to blunt and seven to penetrating trauma.
An acquired diaphragmatic hernia adh is usually the result of a blunt or penetrating injury. The records of all the patients operated for traumatic diaphragmatic hernia at s. Background the incidence of diaphragmatic rupture after blunt thoracoabdominal trauma has an incidence ranging from 1% to 3%1. Recurrent diaphragmatic hernia 3 years after initial repair for traumatic diaphragmatic rupture.
The diaphragm forms in babies at eight weeks of gestation. Diaphragm injuries are diagnosed in the acute phase of blunt trauma only in 10% of casesmore often they are presented as hernia. Moga department of pediatric surgery, grigore alexandrescu clinical emergency hospital for children, bucharest, romania. Surgical instruments are placed in the other small openings and used to repair the diaphragmatic hernia. Delayed presentation of traumatic diaphragmatic rupture with. Most injuries are due to vehicularrelated incidents 79. Early diagnosis of diaphragmatic rupture after traumas may be difficult, and delayed diagnosis may result in increased morbidity and mortality. Injur ies to the diaphragm can result in impaired breathing and circulation. And they may stay unrecognized after injury, only presenting months or years later with strangulation of an incarcerated abdominal viscus and respiratory compromise owing to reduced intrathoracic volume. Surgical repair of traumatic diaphragmatic hernia clinician. Since diaphragmatic injuries are difficult to diagnose, those that are missed may present with latent symptoms of bowel obstruction and strangulation. Outline anatomy embryology anatomic variants diaphragmatic hernias congenital. Congenital diaphragmatic hernia is essentially a defect in the diaphragm that occurs in the uterus. Imaging department reportimaging department reportdr dinhdr dinh 2.