CROSSFIT TRAINING-RELATED SPONTANEOUS DIAPHRAGMATIC RUPTURE: A CASE REPORT

Abstract

SESSION TITLE: Cardiovascular Cases SESSION TYPE: Med Student/Res Case Report PRESENTED ON: 10/22/2019 3:45 PM - 4:45 PM INTRODUCTION: Spontaneous diaphragmatic rupture (DR) is extremely rare. Less than 50 cases have been reported. Spontaneous DR is a loss of the continuous solution of the diaphragm that can lead to the introduction of the abdominal viscera into the pleural cavity, it results from a variety of conditions, such as vigorous exercise, parturition, coughing, all this status conditioning an increase intraabdominal pressure without evidence of any trauma. CrossFit training is a form of exercise that incorporates rapid and successive high-intensity ballistic movements, recognized as one of the fastest growing modes of high-intensity functional training. The studies reported controversial evidence of the higher risk of injuries in the people training CrossFit. To our knowledge, there has been no reported cases in which the spontaneous rupture of the diaphragm was associated with CrossFit training. CASE PRESENTATION: A 28-year-old man visited the physician office (PO) reporting pain in the thoracic and epigastric area. The patient's complaints started 1 day before visiting the PO during CrossFit Training while he was weightlifting. He reported that he felt a stabbing pain in his thoracic and epigastric area that had become progressively worsened. On admission, the patient's vital signs were stable. Abdominal ultrasound revealed no abnormal signs. Chest radiograph showed an elevated left diaphragm. He was sent home but returned to the PO the following day with worsened pain. A CT scan was obtained and spontaneous diaphragmatic rupture with passage of peritoneal structures of the abdominal cavity was diagnosed. He immediately underwent primary repair of the diaphragm and relocation of the stomach and bowel was performed. After 7 days from the onset, he was discharged without any sequelae. DISCUSSION: Approximately 1% of DRs are reported to occur spontaneously. In this case spontaneous DR was caused by a sudden increase in abdominal pressure resulting in a pressure gradient across the diaphragm, such as heavy physical effort and sudden twisting movements. Although some cases of spontaneous DR followed by strenuous sport activities were reported in the medical literature, there has been no previous report of a case of spontaneous DR after CrossFit. As a result, increased abdominal pressure contributed to the rupture of the diaphragm. We believe that this is how our patient was injured. Spontaneous DR should be suspected if there is an abnormal diaphragmatic elevation in a patient who presents with sudden epigastric area pain after a static sport activity, such as CrossFit training. CONCLUSIONS: Spontaneous DR associated with physical exercise is a rare entity, however it should be suspected since it requires timely management to avoid complications. Since CrossFit training is a relatively new high intensity sport, further investigations must evaluate the safety and the risks of practicing this sport. Reference #1: Vilaro MF, Montano LG, Monroig HG, Rodriguez AD, Fernandez R, Rosario MG-D. CHRONIC COUGH CAUSING AN UNEXPECTED COMPLICATION. CHEST. 2018 Oct 1;154(4):1070A. Reference #2: Yang YM, Yang HB, Park JS, Kim H, Lee SW, Kim JH. Spontaneous diaphragmatic rupture complicated with perforation of the stomach during Pilates. Am J Emerg Med. 2010 Feb;28(2):259.e1-259.e3. Reference #3: Claudino JG, Gabbett TJ, Bourgeois F, Souza H de S, Miranda RC, Mezêncio B, et al. CrossFit Overview: Systematic Review and Meta-analysis. Sports Med - Open. 2018 Feb 26;4(1):11. DISCLOSURES: No relevant relationships by Daniel Arturo Herbert Anaya, source=Web Response No relevant relationships by José Antonio Meade Aguilar, source=Web Response No relevant relationships by Carlos Romero, source=Web Response