Post-traumatic Diaphragmatic Hernia Research Articles

Post-traumatic diaphragmatic rupture: two observations at the National Hospital of Niamey

Introduction: Trauma to the diaphragm is rare, accounting for 3.6% of injuries sustained in road accidents. They are the result of violent trauma and most often occur in the left dome. Observations: The two patients were young adults (18, 55), male, and all victims of road traffic accidents resulting in firm trauma to the thorax. All patients had left basithoracic lesions. Both patients were diagnosed intraoperatively based strong clinical and radiological suspicion. The diaphragm ruptures presented by our patients were found on the left, with intra-abdominal viscera ascending into the thorax. Therapeutically, an emergency exploratory laparotomy was performed. The approach was abdominal for two patients, and the surgical procedure involved lowering the herniated organs and suturing the diaphragm for both patients. Postoperative management was straightforward. Conclusion: Post-traumatic diaphragmatic hernia is a particular injury in traumatology. It most often occurs in the setting of polytrauma. Its seriousness derives from its complications and associated lesions, which can be life-threatening.

MINIMALLY INVASIVE MANAGEMENT OF CHRONIC POST-TRAUMATIC DIAPHRAGMATIC HERNIA WITH DELAYED CLINICAL MANIFESTATION

Background: Post-traumatic diaphragmatic hernia (PTDH) is a rare condition that can transition from acute to chronic states, often eluding immediate diagnosis due to obscured symptoms in the emergency setting. The delayed manifestation of PTDH can lead to severe complications such as intestinal obstruction and respiratory distress associated with high rates of morbidity and mortality. Case description: We report a case involving a 74-year-old female patient with delayed onset of symptoms of chronic PTDH (CPTDH) with a history of traffic accident three years before presentation, successfully treated with a minimally invasive laparoscopic approach. Conclusion: Early recognition and adequate management of CPTDH are crucial for minimizing morbidity and mortality. Minimally invasive techniques provide notable benefits in patient care, underscoring the ongoing advancement in surgical approaches.

Posttraumatic diaphragmatic hernia revealed by an occlusive syndrome: A case report

Posttraumatic diaphragmatic hernia revealed by an occlusive syndrome: A case report

Atypical course of incarcerated post-traumatic diaphragmatic hernia

The article focuses on the instrumental imaging methods which greatly enhance the possibilities when arriving at correct and quick diagnosis of acute surgical pathology. Analysis of clinical and anamnestic data of the disease course and the results of instrumental research methods made it possible to arrive at clear clinical diagnosis, determine the indications for surgical treatment in this specific clinical case. The use of modern visualization methods while examining the patients prevents errors in diagnosis and helps to determine the optimal treatment tactics.

Post-traumatic diaphragmatic hernia in a child (case report)

Post-traumatic diaphragmatic hernia in a child (case report)

Post-traumatic diaphragmatic hernia in a child (case report)

Post-traumatic diaphragmatic hernia in a child (case report)

Post-traumatic diaphragmatic hernia in a child (case report)

Post-traumatic diaphragmatic hernia in a child (case report)

Post-Traumatic Diaphragmatic Hernia: A Rare Surgical Emergency in Children: A Case Report from Mohamed V Hospital, Tangier, Morocco

Traumatic ruptures of the diaphragmatic dome are rare in children and are generally related to a road accident. However, they can be life threatening. We report a new case of diaphragmatic rupture hospitalized in the department of pediatric surgery at the Mohammed V Hospital in Tanger. The case involved a 3-year-old boy who was admitted to the emergency room of the Mohammed 5 Hospital in Tanger for thoracic contusion and multiple skin lesions following a traffic accident. The child remained conscious. His hemodynamic status was stable, SO2= 96% on room air without chest deformity. The diagnosis was suspected on the chest X-ray and confirmed by the thoraco-abdominal CT scan. After clinical stabilization, the child underwent a surgical cure. The evolution was favorable. The diagnosis of the diaphragmatic hernia is difficult and requires a CT scan. The surgical treatment allows the reintegration of the herniated organs and the suture of the breach. The prognosis is in most cases favorable.

Renal Replacement by Thoracic Approach in Traumatic Diaphragmatic Hernia with Thoracic Kidney: Case Report

An acquired diaphragmatic hernia usually occurs after thoracoabdominal trauma, causing a defect in the diaphragm that allows the migration of intraperitoneal structures into the thoracic cavity. The finding of renal involvement has a low incidence. The diagnosis of diaphragmatic hernias is based on chest x-ray and computed tomography. Treatment is surgical, due to the risk of strangulation, and consists of content reduction, resection of the sac, and closure of the hernia defect. It can be performed through the thoracic or abdominal approach, with an increasing number of minimally invasive techniques, which reduce trans and postoperative complications. We present the case of a patient with a diagnosis of late-onset post-traumatic diaphragmatic hernia with renal involvement, treated surgically through a thoracic approach with an attempt to preserve the kidneys, who finally underwent nephrectomy due to urinoma secondary to a lesion of the renal pelvis during the mobilization of the kidney to the abdominal cavity.

Features of diagnosis and treatment of false post-traumatic diaphragmatic hernias

Damage to the diaphragm domes followed by the formation of false diaphragmatic hernias (FDH) occurs with closed and open trauma to the chest and/or abdomen. In this case, the mobile organs of the abdominal cavity, being uncovered by the parietal peritoneum, move to the pleural cavity and, with a small defect in the diaphragm, can be infringed up to necrosis of the organ wall. The rare occurrence of such pathology, the paucity of clinical symptoms, explains the high error rate in diagnosis, especially in primary health care. We have experience in two clinics over 34 years in the treatment of 12 patients with FDH. The left dome was damaged in 10 patients, the right dome in two. The age of damage to the diaphragm ranged from several hours to 7 years. Five clinical examples are presented, combined with the late diagnosis of the disease, the difficulties of diagnosis, even in a clinic using modern imaging tools. All patients are operated on both as planned and as an emergency. Endovideosurgical technologies for diagnosis and treatment are used only in 2 patients. 2 (16.67 %) patients died with a false diaphragmatic hernia due to a severe closed injury against the background of traumatic and hemorrhagic shocks. Conclusions. A clear explanation of the origin of scars on the skin of the chest and abdomen, clarification of the mechanisms and severity of closed injuries in the https://panor.ru/articles/osobennosti-diagnostiki-i-lecheniya-lozhnykh-posttravmaticheskikh-diafragmalnykh-gryzh/92437.html

A rare case of delayed presentation of post traumatic diaphragmatic hernia presented with intestinal obstruction

Traumatic diaphragmatic injuries are rare complications resulting from a thoracic-abdominal blunt or penetrating trauma. Diaphragmatic injury is a rare entity and clinically difficult to be diagnosed as symptoms are often masked due to associated injury in poly trauma case. There are no specific signs and symptoms for diagnosing diaphragmatic rupture. High degree of clinical suspicion is needed in all cases of thoroco-abdominal injury to diagnose a case of diaphragmatic rupture. Left sided diaphragmatic injuries are more commonly reported in literature.

Diaphragmatic injury post blunt trauma precipitating a year later as tension fecopneumothorax and left liver lobe herniation: Lesson to learn

Bowel perforation leading to feco-pneumothorax is rare yet serious acute emergency with poor prognosis, requiring urgent surgical intervention and often intensive postoperative care. Worldwide, there are a handful of case reports of missed post traumatic diaphragmatic hernia of which feco-pneumothorax as presentation is even rarer. Here, we report a case of 38 years old male who following RTA one year ago developed left side hemopneumothorax with 4th–6th rib fracture with right shaft of femur fracture, which was managed by left ICD, open reduction with internal fixation of shaft of femur, antibiotics & analgesics. He was then discharged after uneventful hospitalization. Patient was asymptomatic in interim until one day, he presented to emergency and diagnosed with feco-pneumothorax due to perforation of herniated bowel along with herniation of falciform ligament and segment of left liver lobe through an anteromedial diaphragmatic rent.

Laparoscopic approach in chronic posttraumatic diaphragmatic hernia.

Chronic posttraumatic diaphragmatic hernia is an unusual disease with challenging diagnosis and treatment. Surgery represents the treatment of choice which can be transabdominal, transthoracic, or combined approach. The principles of surgery consist of herniated visceral organs reduction and diaphragmatic defect closure. This video demonstrates the steps of chronic posttraumatic diaphragmatic hernia repair via a laparoscopic approach and concerning points during the operation.

Ущемление, некроз и перфорация желудка, некроз большого сальника при посттравматической левосторонней диафрагмальной грыже

The rarest clinical case of post-traumatic diaphragmatic hernia complicated by infringement, necrosisand perforation of the stomach into the left pleural cavity-occurring under the mask of spontaneouspneumothorax is described. Thoracocentesis and laparotomy were performed. The pinched stomach withperforation was lowered, the defect of the posterior wall of the stomach was sutured after refreshingthe edge, the large omentum was resected, the transversely colon, small intestine and spleen werelowered. The postoperative period proceeded smoothly, and the patient was discharged on the 14thpostoperative day. Infringement, necrosis and perforation of the posterior wall of the middle third of thestomach body, necrosis of the large omentum, simultaneous infringement of the transverse colon, smallintestine and spleen in post-traumatic diaphragmatic hernia that occurred under the mask of spontaneouspneumothorax are extremely rare pathologies. This case may be a description of interest, first of all, forpracticing surgeons, radiologists and primary care physicians.

P010 FEASIBILITY OF MIDLINE RECONSTRUCTION WITHOUT MYOFASCIAL RELEASE (COMPONENT SEPARATION) AFTER PREOPERATIVE INFILTRATION OF LATERAL ABDOMINAL WALL MUSCULATURE WITH BOTULINUM TOXIN

Abstract Aim Aim of the analysis was to evaluate whether preoperative botulinum toxin infiltration may facilitate anatomical midline reconstruction without the need for – otherwise pre-operative assumed – surgical component separation. Material and Methods Total of 58 patients with complex abdominal wall hernias were included in our single-center retrospective analysis between 03/2015 and 12/2020. Size of the defect, HSV/ACV-ratio, rectus-to-defect-width-ratio (“Carbonell-Index”) as well as risk factors were analyzed. In all patients muscles of the lateral abdominal wall were infiltrated with 300-500 IE of botulinum toxin 4 weeks prior to the abdominal wall reconstruction. CT scans were performed before and 4 weeks after the botulinum toxin infiltration. Results Total of 58 patients (M/F-ratio 36:22), with a mean age of 63.8 years were included in our analysis. Mean BMI was 29.5 kg/m². Total of 50 incisional, 3 umbilical, 2 posttraumatic diaphragmatic hernias and 3 scrotal hernias were analyzed. Surgical component separation after the infiltration with botulinum toxin was necessary in 43% of the cases. Conclusions Preoperative infiltration of the lateral abdominal wall musculature with botulinum toxin facilitated midline reconstruction of the abdominal wall without the need for myofascial release in 57%. Reduction of surgical trauma could therefore be achieved in several patients.

Acute Intestinal Occlusion Revealing a Post-Traumatic Diaphragmatic Strangulated Hernia: A Case Report

Introduction: The post-traumatic diaphragmatic hernia is a particular lesion in traumatology, which may go undetected in the acute phase of the trauma. Its detection is then often made following a digestive or respiratory complication. Acute intestinal occlusion is one of the complications revealing a strangulated diaphragmatic hernia. Case Presentation: 37-years-old patient with acute intestinal occlusion syndrome. His history included a closed thoracoabdominal trauma following a vehicular accident three years ago. The thoracoabdominal CT scan showed a distension of the haemic coves, transverse and ascending colon above a strangulation of the left colonic angle through a left diaphragmatic defect, with left pleural effusion of high abundance, responsible for a pulmonary collapse. The diagnosis retained is an intestinal occlusion on a strangulated post-traumatic left diaphragmatic hernia. Surgical exploration showed a distension of the hail and colic coves above a strangulated left diaphragmatic hernia with necrotic transverse colic content. The patient has benefited of a hernia reduction with transverse colic resection removing the necrotic colon and suture of the diaphragmatic breach. The evolution was favorable. Conclusion: The eventuality of a diaphragmatic hernia must always be suggested in case of violent thoraco abdominal trauma. Among the causes of intestinal occlusion, the strangulation of a diaphragmatic hernia should be considered, especially if there is a history of thoracoabdominal trauma.

Perforated Peptic Ulcer Combined with Posttraumatic Diaphragmatic Hernia in Third Gestation Trimester: a Clinical Case

Background. Gastric and duodenal ulcers are extremely rare in pregnancy, according to published literature. Peptic ulcer is found in 1 per 4,000 pregnant women, a figure probably underestimated due to its hampered diagnosis in pregnancy. Pregnancy peptic ulcer is considered less expected. Perforated gastric and duodenal ulcers comprise about 1.5 % of total acute abdominal diseases, and the perforation rate in ulcer patients ranges within 5–15 %. This complication afflicts the ages of 20–40 years in men much more frequently than in women. Three perforation types occur: free into abdominal cavity (87 %), contained (9 %), into lesser omentum and retroperitoneal tissue (4 %).Materials and methods. The clinical case describes surgical management of posttraumatic diaphragmatic hernia-comorbid perforated gastric ulcer in a pregnant woman in third trimester. Surgery with postoperative patient management enabled for a favourable outcome.Results and discussion. Perforation-entailing gastric and duodenal ulcers in pregnant women have received negligible attention due to rarity in clinical practice. Paul et al. described 14 cases of duodenal perforation in pregnancy, all fatal.Conclusion. Early diagnosis of surgical pathology during gestation is still difficult contributing to the development of severe complications associated with high mortality. The patient’s admission to a level III interspecialty hospital was key to enable a timely consilium-driven decision of caesarean intervention for saving the child, diagnosing intraoperatively life-threatening complicated surgical diseases and opting for radical surgery that ended in a favourable outcome.

Hérnia Diafragmática à Direita: Um Relato de Caso

Resumo: Relato de caso de um paciente com hérnia diafragmática direita crônica. Paciente em emergência de hospital referência de trauma com obstrução intestinal grave. Hérnia diafragmática pós-traumática é uma injúria pouco encontrada na prática médica, principalmente quando acomete o hemidiafragma direito. As rupturas do lado direito estão associadas a alta morbi-mortalidade e, portanto, o subdiagnóstico de lesões à direita pode ser devido a uma maior mortalidade pré-hospitalar ou a um atraso no diagnóstico intra-hospitalar, muitas vezes em consequência do grau variável de acometimento traumático. A ruptura diafragmática contusa, por ser uma condição pouco frequente, deve ter alto índice de suspeição nos pacientes vítima de trauma tóraco-abdominal, independente do mecanismo de trauma. A associação com lesões múltiplas e graves é frequente, apresentando considerável taxa de morbi-mortalidade, devido aos riscos de complicações imediatas e tardias envolvidas no atraso diagnóstico.

CT-fusion-guided thoracic endovascular aortic repair: Case report and literature review

Interventional and hybrid methods of treatment, combining open surgical and endovascular repairs, are the most promising areas in the surgery of the thoracoabdominal aorta. Recent studies, however, have demonstrated that complex thoracic endovascular aneurysm repair (TEVAR) is one of the most high-dose endovascular interventions. In addition, TEVAR is associated with the use of a significant volume of contrast media (CM), which can lead to contrast-induced acute kidney injury (CI-AKI). The use of advanced imaging techniques and computed tomographic fusion (CT-fusion) in routine practice can potentially reduce operation duration, radiation exposure and CM volume usage. We analyzed the literature on CTfusion in endovascular aortic repair and present a clinical case of a 50-year-old male with a history of concomitant blunt chest trauma. CT of the chest revealed an aneurysm of the arch and descending aorta after traumatic dissection of the aorta (IIIa DeBakey, type B Stanford), post-traumatic diaphragmatic hernia of the left dome of the diaphragm with stomach and intestinal loops prolapse. The patient underwent a staged hybrid intervention — subtotal aortic arch debranching followed by CT-fusion-guided semi-arch TEVAR. CT-fusion is a dynamically developing technology, may reduce the CM volume, the duration of the procedure and radiation exposure and requires further research.

The course of delayed right-sided post-traumatic diaphragmatic hernia with dislocation of the liver into the chest cavity

A rare clinical case of delayed post-traumatic hernia of the right dome of the diaphragm with dislocation of the liver into the chest cavity without dysfunction of the liver, lungs, and the absence of hemodynamic disturbances is described. At the outpatient stage, during the planned fluorography in patient N, in the projection of the lower lobe of the right lung, a single round-shaped darkening with dimensions 11499 mm was revealed. To clarify the diagnosis, the patient was admitted to the clinic of hospital surgery military medical Academy named after S. M. Kirov in a planned manner. Based on the results of the examination and a thorough collection of anamnesis, the final diagnosis was established: Right-sided post-traumatic hernia with dislocation of the liver into the chest cavity. This complication is extremely rare. The literature describes isolated clinical examples of such a pathology. This is due to the peculiarities of the anatomical structure, namely, with the protective function performed by the liver. It prevents other organs of the peritoneal cavity from lobbying into the chest cavity. However, in this unique case, liver migration after a closed abdominal trauma was described. It is not unimportant that this clinical case was accompanied by a meager clinical picture, the absence of complaints from patient N., and normal indicators of the method performance of laboratory diagnostic techniques. The mortality rate for diaphragm ruptures can reach 31% in the first days after injury. Therefore, the diagnosis of diaphragmatic hernia requires exclusion in all patients with chest and / or abdominal trauma.