Diaphragmatic Rupture Research Articles

Esophageal Injury Masquerading as Diaphragmatic Injury

Esophageal Injury Masquerading as Diaphragmatic Injury

Laparoscopic management of delayed traumatic left diaphragmatic hernia with intrathoracic kidney: A rare case report and technical aspects

Abstract Occult traumatic diaphragmatic hernias (DHs) are relatively rare and may present years after the trauma. Clinical presentations range from asymptomatic incidental findings on imaging to life-threatening incarceration of abdominal organs. Traumatic migration of the kidney into the thorax is a very uncommon event. We herein report a rare case of a 34-year-old male patient with a symptomatic DH secondary to a motor vehicle accident and a history of laparotomy for liver laceration 10 years back who underwent laparoscopic reduction and intraabdominal reposition of left kidney from thorax, suture repair of the defect with mesh reinforcement. Thoracoscopic visualization was performed to assess the efficiency and completeness of the repair and to rule out any iatrogenic pericardial injury after mesh fixation. The operative technique, difficulties encountered, and tips to overcome these challenges were discussed. With adequate expertise, reduction, and repositioning of migrated kidney, suture closure of the defect with mesh reinforcement is safe and feasible by laparoscopic approach.

Right Side Chest Stab Wound with Perforation in Diaphragm and Liver Laceration: A Case Report

Liver is one of the organs with the highest injury rate, and in recent decades, the guidelines for the treatment of liver trauma have changed considerably. Now, there is a growing consensus that the most important step is diagnosis and depending upon the degree of severity, non-operative therapy is the main treatment method for hepatic trauma if conditions permit. For serious hepatic trauma patients such as those with hemodynamic instability, they should be operated upon as soon as possible. Regardless of the surgical options, doctors should control damage to patients and try to prevent complications. New therapies such as hepatic artery Embolization and liver transplantation. Our case was a 24 years old man with right chest penetrating wound by stab that perforated diaphragm and lacerated liver that both of them was repaired. Management of liver trauma is multidisciplinary. Diaphragmatic injury may be underestimated due to the presence of concomitant lesions of other organs, to a state of shock and respiratory failure, and to the difficulty of identifying diaphragmatic injuries in the absence of high sensitivity and specific diagnostic instruments.

The natural history of unrecognized diaphragmatic hernias after blunt trauma: A narrative review and presentation of three clinical cases

A diaphragmatic hernia may be the consequence of a blunt traumatic diaphragm rupture, representing a frequently misunderstood post-traumatic complication. Although it is uncommon, it may be associated with high morbidity and mortality when diagnosed late. An extensive review was conducted using the PubMed/MEDLINE (National Library of Medicine, Bethesda, USA) database for articles published in the English language. Three very interesting clinical cases are presented to demonstrate the clinical aspects of the reviewed evidence. They can show how the misrecognition of a left diaphragmatic rupture after a closed trauma can cause serious complications. Tension viscerothorax associated with hemodynamic shock is an example, which represents both an extremely rare and life-threatening complication.

Effect of Individualized PEEP Guided by Driving Pressure on Diaphragm Function in Patients Undergoing Laparoscopic Radical Resection of Colorectal Cancer: A Randomized Controlled Trial.

BACKGROUND The concept of driving pressure (ΔP) has been established to optimize mechanical ventilation-induced lung injury. However, little is known about the specific effects of setting individualized positive end-expiratory pressure (PEEP) with driving pressure guidance on patient diaphragm function. MATERIAL AND METHODS Ninety patients were randomized into 3 groups, with PEEP set to 0 in group C; 5 cmH₂O in group F; and individualized PEEP in group I, based on esophageal manometry. Diaphragm ultrasound was performed in the supine position at 6 consecutive time points from T0-T5: diaphragm excursion, end-expiratory diaphragm thickness (Tdi-ee), and diaphragm thickening fraction (DTF) were measured. Primary indicators included diaphragm excursion, Tdi-ee, and DTF at T0-T5, and the correlation between postoperative DTF and ΔP. Secondary indicators included respiratory mechanics, hemodynamic changes at intraoperative d0-d4 time points, and postoperative clinical pulmonary infection scores. RESULTS (1) Diaphragm function parameters reached the lowest point at T1 in all groups (P<0.001). (2) Compared with group C, diaphragm excursion decreased, Tdi-ee increased, and DTF was lower in groups I and F at T1-T5, with significant differences (P<0.05), but the differences between groups I and F were not significant (P>0.05). (3) DTF was significantly and positively correlated with mean intraoperative ΔP in each group at T3, and the correlation was stronger at higher levels of ΔP. CONCLUSIONS Individualized PEEP, achieved by esophageal manometry, minimizes diaphragmatic injury caused by mechanical ventilation based on lung protection, but its protection of the diaphragm during laparoscopic surgery is not superior to that of conventional ventilation strategies.

Study of rupture behavior of 40Cr ring-scored bursting diaphragms

The rupture diaphragm is a key part of pressure control in the launcher and the reliability of the rupture pressure is directly related to the internal ballistic performance. In order to study the rupture behavior of the 40Cr annular scored diaphragm under internal ballistic conditions and the remaining thickness of the diaphragm’s scoring, the stress-strain curve of the diaphragm is obtained by fitting the internal ballistic loading curve and simulation, the relationship between the rupture pressure and the remaining thickness of the scoring is established and the accuracy of the simulation is verified by the blasting test.

Post Traumatic Diaphragmatic Hernia with Intrathoracic Stomach Outlet Complicated by Strangulation in an Adult: About A Case and Review of the Literature

A 65-year-old patient was seen urgently for diffuse abdominal pain of abrupt onset. The physical examination was unremarkable. A CT scan revealed a left-sided posterior median diaphragmatic defect with antropyloric incarceration responsible for gastric stasis surrounded by medial fat infiltration.

Prevention of inadvertent injury of diaphragm during posterior peroral endoscopic myotomy for achalasia cardia

Prevention of inadvertent injury of diaphragm during posterior peroral endoscopic myotomy for achalasia cardia

Dynamic equilibrium of skeletal muscle macrophage ontogeny in the diaphragm during homeostasis, injury, and recovery

The diaphragm is a unique skeletal muscle due to its continuous activation pattern during the act of breathing. The ontogeny of macrophages, pivotal cells for skeletal muscle maintenance and regeneration, is primarily based on two distinct origins: postnatal bone marrow-derived monocytes and prenatal embryonic progenitors. Here we employed chimeric mice to study the dynamics of these two macrophage populations under different conditions. Traditional chimeric mice generated through whole body irradiation showed virtually complete elimination of the original tissue-resident macrophage pool. We then developed a novel method which employs lead shielding to protect the diaphragm tissue niche from irradiation. This allowed us to determine that up to almost half of tissue-resident macrophages in the diaphragm can be maintained independently from bone marrow-derived monocytes under steady-state conditions. These findings were confirmed by long-term (5 months) parabiosis experiments. Acute diaphragm injury shifted the macrophage balance toward an overwhelming predominance of bone marrow (monocyte)-derived macrophages. However, there was a remarkable reversion to the pre-injury ontological landscape after diaphragm muscle recovery. This diaphragm shielding method permits analysis of the dynamics of macrophage origin and corresponding function under different physiological and pathological conditions. It may be especially useful for studying diseases which are characterized by acute or chronic injury of the diaphragm and accompanying inflammation.

Risk Factors for Empyema Following Penetrating Diaphragmatic Injuries.

Empyema resulting as a complication of penetrating diaphragmatic injuries is a subject that requires further investigation, and the aim of this study was to determine the risk factors associated with empyema in patients with penetrating trauma. Consecutive adult trauma patients from a level 1 trauma center were searched for penetrating diaphragm injuries. Data were collected on patient demographics, pre-existing conditions, injury type and severity, hospital interventions, in-hospital complications, and outcomes. Patients were stratified by empyema formation and univariant analyses were performed. 164 patients were identified, and 17 patients (10.4%) developed empyema. Empyema was associated with visible abdominal contamination (35.3% vs 15%, P = .04), thoracotomy (35.5% vs 13.6%, P = .03), pneumonia (41.2% vs 14.3%, P = .01), sepsis (35.3% vs 8.8%, P = .006), increased hospital length of stay (25.5 vs 10.1 days, p =<.001), increased intensive care unit length of stay (9.6 vs 4.3 days, P = .01), and decreased in-hospital mortality (0% vs 20.4%, P = .04).

Right Diaphragmatic Rupture with Total Passage of the Liver into the Thorax: A Case Report

Traumatic rupture of the right diaphragmatic dome with herniation of the liver into the thorax is a rare lesion. It is often part of a polytrauma, for which it is a criterion of severity. Whether early or late, it exposes the patient to cardiopulmonary complications due to compression. Right diaphragmatic rupture is difficult to diagnose. Its clinical signs are not very specific, and imaging can be misleading, as it visualizes the ascending organs but not the rupture itself. The thoracic approach is often preferred because of the difficulty of exposing the diaphragm in the presence of the liver. We report a case of right diaphragmatic rupture with total passage of the liver into the thorax following an MVA in a polytrauma patient.

Point of care ultrasound and sub-xiphoid window reduce uncertainty in the management of potential dual-cavity injuries in patients with torso stab wounds

IntroductionThis paper reviews our experiences with the management of patients with torso stab wounds and potential injuries in both the chest and abdomen over the last decade. The aim of the project is to clarify our approach and provide an evidence base for clinical algorithms. We hypothesize that there is room for our clinical algorithms to be further refined in order to address the diverse, life threatening injuries that can result from stab wounds to the torso. MethodsPatients with one or more torso stab wounds, and a potential injury in both the chest and the abdomen were identified from a local database for the period December 2012 to December 2020. ResultsA total of 899 patients were identified. The mean age was 29 years (SD = 9) and 93% of patients were male. Amongst all patients, 686 (76%) underwent plain radiography, 207 (23%) a point of care ultrasound assessment, and 171 (19%) a CT scan. Following initial resuscitation, assessment and investigation, a total of 527 (59%) patients proceeded to surgery. A total of 185 patients (35%) underwent a semi elective diagnostic laparoscopy to exclude an occult diaphragm injury. Of the 342 who underwent an emergency operation, 9 patients (1%) required thoracotomy or sternotomy exclusively, 299 patients (33%) required a laparotomy exclusively and 34 patients (4%) underwent some form of dual cavity exploration. In total, there were 16 deaths, a mortality rate of 2%. The use of laparoscopy, point of care ultrasound and subxiphoid pericardial window increased over the period of this study. ConclusionsPatients with torso stab wounds and potential injuries above and below the diaphragm are challenging to manage. The highly structured clinical algorithm of the ATLS course should be complemented by the use of point of care ultrasound and sub-xiphoid window to assess the pericardium. These adjuncts reduce the likelihood of negative exploration and incorrect operative sequencing.

Traumatic Rupture of the Diaphragm About 19 Cases

Traumatic ruptures of the diaphragm (TRD) are serious lesions that are often part of polytrauma. The diagnosis of wounds and diaphragmatic rupture remains difficult and often delayed. Methods: We conducted a descriptive observational study with retrospective data collection. It took place in two referral hospitals in Algeria. Results: Our study involved 19 cases of diaphragmatic injuries. The sex-ratio was 8.5. The mean age was 29 years. Traffic accident represented 78.95%. The diaphragmatic rupture was on the left side in 84.21 % (16 cases). The surgical procedure involved a reduction of herniated viscera and a suture of the diaphragm by “X” non absorbable points in 73.68 % (15 cases). The evolution was favorable in all patients, except one death. Conclusion: A diaphragmatic rupture is often integrated into a polytrauma, of which it is a criterion of Severity; however the diagnosis may be overlooked in the acute phase because it poses a real diagnostic and therapeutic challenge.

Risk factors for diaphragmatic injury in subxiphoid video-assisted thoracoscopic surgery.

Subxiphoid video-assisted thoracoscopic surgery (VATS) is considered a safe and feasible operation for anterior mediastinal mass resection. However, diaphragmatic injury, presented as tearing or puncturing, may occur during subxiphoid VATS despite of low incidence. This study aims to explore risk factors for diaphragmatic injury in subxiphoid VATS, as well as strategies to reduce occurrence of the injury. We retrospectively reviewed clinical records of 44 consecutive adult patients who underwent subxiphoid VATS. These patients were divided into two groups: diaphragmatic injury group and non-injury group. Perioperative outcomes and anatomic features derived from 3D CT reconstructions were compared between the two groups. Significant differences were observed in operation time (223.25 ± 92.57 vs. 136.28 ± 53.05, P = 0.006), xiphoid length (6.47 ± 0.85 vs. 4.79 ± 1.04, P = 0.001) and length of the xiphoid below the attachment point on the diaphragm (24.86 ± 12.02 vs. 14.61 ± 9.25, P = 0.029). Odds ratio for the length of the xiphoid below the attachment point on the diaphragm was 1.09 (1.001-1.186), P = 0.048 by binary logistic regression analysis. We identified the length of the xiphoid below the attachment point on the diaphragm as an independent risk factor for diaphragm injury during subxiphoid VATS. Prior to subxiphoid VATS, a 3D chest CT reconstruction is recommended to assess the patients' anatomic variations within the xiphoid process. For patients with longer xiphoid process, a higher incision at the middle and upper part of the xiphoid process, and partial xiphoid process resection or xiphoidectomy is preferred.

Stab Chest with Diaphragmatic Rupture and Herniated Stomach

Stab Chest with Diaphragmatic Rupture and Herniated Stomach

Delayed presentation of traumatic hepatothorax: An anesthetic and surgical perspective

: Traumatic diaphragmatic hernia is an uncommon sequela of blunt and penetrating trauma. It is estimated that 0.8–1.6% of patients with blunt trauma develop diaphragmatic rupture. However, the diagnosis of this condition is often overlooked, with right-sided hernias missed more frequently than left-sided hernias. Early diagnosis and repair are essential to prevent future complications such as strangulation and ischemia of intra-abdominal organs, lung collapse, and cardiovascular demise.: A 17-year-old male (180 cm; 86 kg) with no comorbidities presented to the emergency department (ED) following a high-velocity, unrestricted, rear-ended motor vehicle crash (MVC). The patient was intubated and hemodynamically stabilized in the ED, with planned surgical exploration of the abdomen. Six days following the accident, the patient was extubated; he became increasingly hypoxic and tachypneic over the next day. A CT of the chest and pelvis was ordered, confirming the diagnosis of a post-traumatic right-sided diaphragmatic hernia. An exploratory laparotomy was scheduled. Difficulties with ventilation were encountered due to suspected lung compression by the liver and movement of the endotracheal tube into the right main lung bronchus. : Traumatic diaphragmatic hernia should be considered in all patients presenting with abdominal trauma and should be suspected if respiratory distress arises during the patient’s clinical course. The recommended anesthetic approach is rapid sequence intubation with a cardiovascular-stable agent like etomidate and gastric decompression. Difficulties with intubation and ventilation should be anticipated due to the presence of the visceral organs within the thoracic cavity.

Case Report: The Diaphragmatic Hernia: A Rare Cause of Intestinal Obstruction

We present the case of a 22-year-old patient, with congenital diaphragmatic hernia, diagnosed at an advanced stage due to an occlusive syndrome observed on the CT scan, revealing colonic distension upstream of a strangulated Bochdalek's diaphragmatic hernia. The patient underwent laparotomy, where the hernia was reduced, and the diaphragmatic rupture was closed. The purpose of this article is to highlight a rare cause of intestinal obstruction, which is strangulated diaphragmatic hernia, when the diagnosis and detection of complications are confirmed through CT scan, allowing for early management.

Hemothorax Due to Transdiaphragmat-ic Liver Penetrating Injury Caused by Broken Knife

Thoracic trauma is one of the most fatal cases of patients admitted to emergency departments. Thoracic trauma occurs in 20–25% of all trauma patients worldwide and is the third cause of trauma-related deaths. Approximately 5% of trauma admissions are liver injuries. In some blunt or penetrating injuries, both intrathoracic and intra-abdominal organs may be injured. It is aimed to present the case of a broken knife entering from the right paravertebral location, causing hemothorax as a result of diaphragm and liver injury without injuring the lungs, due to the importance of the multidisciplinary approach among surgical departments in the study.&#x0D; A 44-year-old male patient was admitted to the emergency department due to penetrating injury. An oblique injury of approximately 5 cm was seen in the posterior part of the right hemithorax. Radiologically, It was detected that the knife, which entered through the 10th intercostal space, was stuck inside and the knife handle was broken. It was observed that the broken blade entered from the paravertebral region, passed into the intrathoracic area, causing hemothorax, and passed from the edge of the inferior vena cava and embedded itself in the liver. Multidisciplinary operation planning was made among the departments. All department surgeons were present in the operating room at the same time. The paravertebral space was assessed and the embedded blade was slowly withdrawn by the neurosurgeon. Explorative laparotomy was done by the general surgeon and gastroenterology surgeon. Transdiaphragmatic injury was evaluated by the thoracic surgeon and major vascular structures were evaluated by the cardiovascular surgeon. In the postoperative period, the patient was discharged on the 5th postoperative day with full recovery without any complications.&#x0D; Penetrating trauma is one of the most fatal cases of patients admitted to emergency departments. In some cases, intrathoracic and intra-abdominal penetrating injury may occur together, rarely from a single entrance location. The timing of critical intervention varies depending on whether the patient's vitals are stable or unstable. If the hemodynamics are stable in penetrating injuries, all affected anatomical structures should be evaluated with radiological examinations. For successful, uncomplicated surgical treatments, controlled techniques, interdepartmental consensus and, when necessary, simultaneous presence of surgeons in the surgery are essential

Diaphragmatic Trauma About 14 Cases

Introduction: Traumatic injury or rupture of the diaphragm is a rare consequence of thoracic and abdominal trauma. The aim of this study was to determine the epidemiological profile, the etiological mechanisms, the elements of the diagnosis, as well as the therapeutic modalities. Patients and Methods: This was a retrospective study carried out in the visceral surgery department of the Mohammed VI University Hospital of Marrakech over a period of 5 years between January 2017 and December 2022. Epidemiological parameters, clinical characteristics, treatment and prognosis of patients operated for diaphragm trauma were studied. Results: Fourteen patients with diaphragmatic trauma were operated on. Road accidents were the most representative etiological mechanism with 71% of cases (10 cases out of 14), including cars, motorcycles and pedestrians, For the remaining 4 cases, the rupture occurred following falls with basithoracic reception in 2 cases and following a thoraco-abdominal penetrating wound in 2 cases. The rupture involved the left diaphragmatic dome in eight cases, the right dome in four cases and it was bilateral in two patients. The diagnosis was confirmed in pre-operation by different imaging techniques, in particular computed tomography and in two cases by MRI. Essentially by the median route, treatment consisted of closure of the diaphragmatic breach by simple sutures and in some patients, the use of prosthetic equipment was indicated. Conclusion: Diaphragmatic ruptures occupy a special place in traumatology. They are evidence of severe trauma. They are sometimes unrecognized, either because of dominant associated lesions or because of the povertý of clinical signs and the low sensitivitý of common paraclinical examinations.

Delayed Presentation of Traumatic Diaphragmatic Rupture With Hemothorax

Delayed Presentation of Traumatic Diaphragmatic Rupture With Hemothorax