Presentation Of Traumatic Diaphragmatic Hernia Research Articles

Ileus and Late-onset Traumatic Diaphragmatic Hernia Presenting with Vomiting and Dyspnea: A Case Report

Ileus and Late-onset Traumatic Diaphragmatic Hernia Presenting with Vomiting and Dyspnea: A Case Report

Late-onset traumatic diaphragmatic hernia associated with acute pancreatitis

Rationale:Acute pancreatitis (AP) is one of the most common diseases of gastroenterological emergency with a highly variable clinical course and the incidence being on the rise in recent years. Posttraumatic diaphragmatic hernia is an uncommon disease and may manifest immediately or several years after the incident. Delayed presentation of traumatic diaphragmatic hernia associated with AP is relatively rare.Patient concerns:A 26-year-old male with history of left chest knife injury 10 years ago, had AP due to delayed traumatic diaphragmatic hernia 5 days after Dragon Boat Race.Diagnoses:Thoracoabdominal computerized tomography detected left diaphragmatic hernia with pancreatic head displacement. Emergency surgery confirmed the diagnosis.Interventions:Emergency surgery to reduce and repair the hernia.Outcomes:The patient was discharged from the hospital on the sixth postoperative day and no recurrence of pancreatitis during follow-up.Lessons:For patients without obvious etiology of AP, clinicians should be highly vigilant and inquire the history in detail. For patients with trauma, the relevant examination should be improved, and the pancreatitis caused by traumatic diaphragmatic hernia should be treated with emergency operation immediately.

An Unusual Cause of Thoracic Pain in a Child

In adults, late presentation of traumatic diaphragmatic hernia is well known. In children it is rarely reported. We report the case of a fourteen-year-old boy that presented on the emergency department of our hospital with progressive pain at the right hemi thorax. Only with a thorough medical history, a relationship between his complaints and a car accident nine years ago could be made. This resulted in the right diagnosis. At first presentation after thoracic and/or abdominal trauma, there must be awareness of the possibility of diaphragmatic rupture, although the prevalence is low. There is a high chance of missing diagnosis by overshadowing complaints and diagnostic difficulties. The hernia can be discovered years after trauma. Management is primarily surgical.

Hernia diafragmática secundaria a trauma: presentación tardía

Introduction: Late presentation of traumatic diaphragmatic hernia constitutes a true surgical emergency. The purposes of this study were to describe the diagnostic characteristics, treatment and outcomes of late presentation diaphragmatic hernias and to identify a cutoff point from the onset of symptoms to necrosis development. Patients and Methods: A retrospective series of cases constituted by all patients subjected to emergency diaphragmatic hernia repair form 2006 to 2016 was studied. Categorical and continuous variables were measured and analyzed with descriptive statistics. Receiver Operating Characteristics (ROC) curves at 6 and 12 hours from the onset of symptoms were used to determine the cutoff point for organ resection. Once stablished the cutoff point, sensitivity, specificity, positive and negative predictive values and prevalence were calculated. Results: Clinical presentation, diagnostic study and surgical treatment were similar to what has been already described. The cutoff point was defined at 12 hours from the onset of symptoms with 80% sensitivity and 83% sensibility. Conclusions: The diagnosis and treatment of these cases should be carried on before the first 6 hours after the onset of symptoms. Even though the universe of this study was small, we may suggest that after 12 hours form the onset of symptoms, the implicated organs would be found necrotic requiring surgical resection.

Delayed Presentation of Traumatic Diaphragmatic Hernia With Associated Gastric Herniation

Delayed Presentation of Traumatic Diaphragmatic Hernia With Associated Gastric Herniation

Delayed Presentation of Traumatic Diaphragmatic Hernia: The Evaluation of Surgical Treatment Results

Introduction: Diaphragmatic hernia could be caused by congenital disorders, blunt trauma or penetrating injuries. The diagnosis of traumatic diaphragmatic hernia is normally neglected during the first presentation leading to late complications and considerably increased mortality and morbidity among the patients. Materials and Methods: In this retrospective, descriptive study, we reviewed the medical records of patients presented with traumatic diaphragmatic hernia who had undergone surgical operations between 1982-2015 in Ghaem Hospital and Omid Hospital affiliated to Mashhad University of Medical Sciences, Iran. The studied variables included age, gender, clinical symptoms, location of hernia, involved organs, type of imaging modalities, surgical techniques, length of hospital stay, mortality rate and surgical complications. Results: In this study, 38 patients were diagnosed with traumatic diaphragmatic hernia consisting of 28 men and 10 women. In total, 79% and 21% of the patients suffered from penetrating trauma and blunt trauma, respectively. In addition, left-sided, right-sided and bilateral hernias were present in 33%, 4% and 1% of the patients, respectively. The most frequently herniated organ was the stomach, and the most common clinical symptoms were abdominal pain (84%) and dyspnea (53%). Initially, chest radiographs were performed on all the patients, and thoracotomy was performed to repair diaphragmatic tears in all the cases (100%). In this study, 3 patients had previously undergone Hartmann’s operation for gangrenous herniated colon, and devolvulation of gastric volvulus had also been performed on 3 patients. The main post-operative complications were reported to be pneumonia and respiratory insufficiency (2 cases), and the mean length of hospital stay was 6 days (5-8 days) which was longer (1-2 months) in patients with gangrenous bowel (3 patients). Furthermore, no mortality was reported during the course of hospitalization in these patients. Conclusion: According to the results of this study, patients presented with blunt or penetrating traumas to the upper abdomen or lower chest require urgent attention as to immediately rule out diaphragmatic hernia in order to prevent later complications and mortality and morbidity among these patients.

Traumatic diaphragmatic hernia presenting late with non respiratory symptoms

A penetrating injury to the chest may cause a diaphragmatic rupture. Presentation can be acute or delayed. Traumatic diaphragmatic hernia (DH) usually presents with symptoms of respiratory compromise. We present a case of a middle-aged man who attended our emergency and diagnosed as acute intestinal obstruction, both clinically and radiologically. A history of stab injury over left chest 10 years back and chest X-ray showed bowel loops in left hemithorax. Diaphragmatic herniation was suspected, although there were no respiratory symptoms on presentation. On laparotomy, a rent of 4 cm × 3 cm was found in the posterolateral aspect of left hemidiaphragm, through which a part of transverse colon and omentum was herniated. The herniated contents were reduced. Closure of the diaphragm followed by loop transverse colostomy was done. The rent was surrounded all around with the ragged diaphragm, which made the possibility of congenital DH unlikely. Thus, a case of traumatic DH was finally diagnosed without respiratory symptoms. With this case we would like to highlight that delayed presentation of traumatic DH may also present with absence of respiratory symptoms.

Delayed presentation of a traumatic diaphragmatic hernia presenting as a large bowel obstruction: a case report

Delayed presentation of a traumatic diaphragmatic hernia presenting as a large bowel obstruction: a case report

Delayed presentation of traumatic diaphragmatic hernia

A 10-year-old boy presented with abdominal pain around the umbilicus since 8 hours, 4 episodes of non-bilious vomiting and pain in the left shoulder since 5 hours. There was no history of fever or bowel disturbances. On examination his general condition was stable. Per abdomen examination revealed tenderness around the umbilicus. Examination of other systems was unremarkable. He had history of chest trauma 7 months back. At that time examination revealed wound measuring 4×2 cm below and lateral to left nipple with normal vitals. Respiratory and abdominal examination was unremarkable. Chest X-ray, sonography and CT scan were normal. Debridement and suture of the wound was done and child discharged after 5 days.During the second admission, his blood counts, urine examination, serum amylase, kidney function test and liver enzymes were within normal limits. Chest X-ray revealed nonvisualization of left diaphragm and presence of distended bowel loops. CT scan showed disrupted left hemidiaphragm with herniation of bowel loops (Fig.1). On laparoscopy, left diaphragm opening was noticed with colon and omentum as contents. Surgeon tried to pull the contents back to abdomen but could not. Therefore laparotomy was performed, contents were reduced (colon was healthy) and closure of diaphram opening was done. Child was discharged after 5 days.

Delayed Presentation of Traumatic Diaphragmatic Hernia: a Diagnosis of Suspicion with Increased Morbidity and Mortality

BackgroundDiaphragmatic rupture due to blunt or penetrating injury may be a missed diagnosis in an acute setting and can present with a delayed complication with significantly increased morbidity and mortality.ObjectivesThe objective of this study is to better understand why diaphragmatic tears with delayed presentation and diagnosis are so often missed and why traumatic diaphragmatic tears are difficult to diagnose in emergency settings and how they present with grievous complications.Patients and MethodsEleven patients with diaphragmatic hernias with delayed presentation and delayed diagnosis were operated within the last five years. All patients presented with different complications like gut gangrene or respiratory distress.ResultsOut of eleven patients who were operated on for diaphragmatic hernia, three patients (27%) died. Three patients required colonic resection, one patient needed gastrectomy and one patient underwent esophagogastrectomy.ConclusionsA small diaphragmatic tear due to blunt trauma to the abdomen is difficult to diagnosis in acute settings due to ragged margins and possibly no herniated contents and usually present with a delayed complication. Therefore a careful examination of the entire traumatized area is the best approach in treating delayed presentation of traumatic diaphragmatic hernia prior to development of grievous complications.

Delayed Presentation of Traumatic Diaphragmatic Hernia: A Case Report

Traumatic diaphragmatic hernias are an unusual presentation of trauma. The diagnosis is often missed because of non-specific clinical signs, and the absence of additional intra-abdominal and thoracic injuries. Thus, a delay in diagnosis may occur which, in the presence of obstruction and/or strangulation, is associated with a high mortality and morbidity.

Presentación tardía de hernia diafragmática traumática con necrosis gástrica

IntroductionTraumatic diaphragmatic hernia frequently is not diagnosed upon the first admission, and late presentation associated to complications of herniated organs is common.Even though, these cases are rare. Herein we discuss a patient with late presentation of traumatic diaphragmatic hernia with gastric necrosis and his surgical treatment. Case descriptionA male patient, 23 years-old, with a previous penetrating wound over the left hemithorax 18 months before admission, presents to the Emergency Unit of our Institution complaining of thoracic pain associated to vomit. A thoracic computed tomography showed a left diaphragmatic hernia with intrathoracic stomach and pleural effusion. Surgical findings were a hernia ring of 3 cm of diameter with almost all stomach herniated into the left hemithorax. Around 90% of the herniated stomach was necrotic as well as the associated greater omentum. A total Gastrectomy was performed. The diaphragmatic defect was repaired with separated polypropylene stitches. Postoperative evolution was uneventful. The histology of the surgical specimen showed hemorrhagic infarct of the stomach wall and mucosal necrosis. DiscussionLate presentation with necrosis of the herniated organs in patients with posttraumatic diaphragmatic hernia represents the habitual presentation in these cases. The diagnosis is facilitated with the use of computed tomography and early surgical intervention has good prognosis.

A Case of Delayed Presentation of Traumatic Diaphragmatic Hernia Successfully Repaired with a PTFE patch

A Case of Delayed Presentation of Traumatic Diaphragmatic Hernia Successfully Repaired with a PTFE patch

Delayed Presentation of Traumatic Diaphragmatic Rupture with Herniation of the Left Kidney and Bowel Loops

Rupture of the diaphragm mostly occurs following major trauma. We report a case of delayed presentation of traumatic diaphragmatic hernia on the left side in a 44-year-old male who presented two weeks after a minor blunt trauma. Left kidney and intestinals coils were found to herniate through the diaphragmatic tear. This case demonstrates the importance of considering the diagnosis in all cases of blunt trauma of the trunk. It also illustrates the rare possibility of herniation of kidney through the diaphragmatic tear.

An undiagnosed left sided traumatic diaphragmatic hernia presenting as small intestinal strangulation: A case report

INTRODUCTIONPost traumatic diaphragmatic hernia is very often missed particularly in polytrauma patients. We present case of an isolated post traumatic diaphragmatic hernia with strangulation, a very rare finding. PRESENTATION OF CASEA 35 year old man presented with features of intestinal obstruction with past history of a seemingly trivial blunt thoracic injury 15 years back. Findings of X-ray abdomen and chest with high leukocyte count raised suspicion of obstructed diaphragmatic hernia which on exploration revealed obstructed diaphragmatic hernia with gangrenous bowel segment. DISCUSSIONBlunt injury of diaphragm is relatively common and is considered as a marker of severe trauma and it can clinically be occult as other violent injuries may mask and disguise its initial clinical presentation1 resulting in late presentation with obstruction and/or rarely strangulation. An early diagnosis of the condition is prudent to avoid morbidity and mortality associated with late presentations. CONCLUSIONIn a patient of intestinal obstruction with history of even trivial throraco- abdominal injury, diagnosis of diaphragmatic hernia should be kept in mind.

A Delayed Traumatic Diaphragmatic Hernia Presenting With a Bowel Obstruction 20 Years Postinjury

A delayed Traumatic Diaphragmatic Hernia is a rare diagnosis. A 38 years old male presented to our emergency department with an acute bowel obstruction. He had a prior trauma laparotomy twenty year's prior, which was reportedly negative. He required preoperative resuscitation for his severe hypokalaemic, hypochloraemic metabolic alkalosis, and acute renal failure. He underwent operative reduction of the incarcerated contents, and a primary permanent suture repair of the defect. The principles of the diagnosis of the delayed traumatic diaphragmatic hernia, and the operative repair of this entity have been reviewed.

Delayed presentation of traumatic diaphragmatic hernia

Delayed presentation of traumatic diaphragmatic hernia

Traumatic diaphragmatic hernia presenting as a tension fecopneumothorax

A traumatic diaphragmatic hernia is a well-known complication following blunt abdominal or penetrating thoracic trauma. Although the majority of cases are diagnosed immediately, some patients may present later with a diaphragmatic hernia. It occurs in approximately 3% of abdominal traumas. Diagnosis requires a high index of suspicion since diaphragmatic injury can only reliably be ruled out by direct visualization, i.e., laparoscopy. Hence, delayed presentation with complications secondary to the injury is not uncommon. We discuss a case of a young man who presented in respiratory distress 5 years after a stab wound to the left chest. The patient was hypoxic, with a chest X-ray (CXR) demonstrating a pneumothorax with effusion. A chest tube was placed with a rush of air and feculent drainage. CT scan revealed an incarcerated transverse colon in a diaphragmatic hernia. The laparotomy demonstrated necrotic colon in the chest with gross fecal contamination in the chest. The diaphragmatic defect was closed and a Hartmann's procedure performed. The patient developed empyema in the postoperative period. Our patient is the twelfth reported case of a tension fecopneumothorax resulting from traumatic diaphragmatic herniation. This paper reviews all cases, including the diagnostic workup, operative approach, and expected postoperative course of this unusual condition.

Delayed Presentation Of Traumatic Diaphragmatic Hernia After 28 Years Of Initial Trauma: Treated Laproscopically

Introduction: Severe external blunt or penetrating trauma to the abdomen and/or chest is the most common cause of traumatic diaphragmatic hernia (TDH). Delayed TDHs, which develop after a period of one month following trauma, are observed in about 10% of diaphragmatic injuries. The stomach and colon are the most common organs found to be herniated. Most patients with delayed TDHs present with acute GI and/or respiratory symptoms, although, for the intervening period, they may be completely asymptomatic, or may give on and off history of mild symptoms. Helical CT has high sensitivity for detection and gives detailed information about the exact anatomy. Transthoracic approach for repair of delayed TDH is preferred. Laparoscopic, thoracoscopic, or combined techniques are also available for repair of TDHs. Here we present an interesting case of delayed TDH, presenting after a very long asymptomatic interval of 28 years of initial trauma. The patient was successfully treated by repair done laproscopically. Conclusion: This case report emphasizes the possibility of delayed presentation of TDH even after very long intervals, and its laparoscopic repair, as one of the available treatment options.

Colobronchial Fistula Complicating a Traumatic Right Diaphragmatic Hernia: A Case Report

The delayed presentation of traumatic diaphragmatic hernia is associated with high morbidity and mortality. Acute colobronchial fistula complicating delayed presentation of traumatic diaphragmatic hernia is previously unreported. A 52-year-old woman presented with a 4-day history of dyspnoea, feculent sputum and chest and abdominal pain 3 months after a road traffic accident. The diagnosis of Chilaiditi's syndrome, diaphragmatic hernia and colobronchial fistula was confirmed with computed tomography (CT) and treated by chest drain, primary hernia repair and right hemicolectomy. Spontaneous decompression through the bronchus had prevented tension fecopneumathorax. The diagnosis of diaphragmatic hernia is difficult but delay is associated with increased mortality. Symptoms include dyspnoea, chest and abdominal pain, with decreased respiratory sounds and visceral sounds in the thorax. Abdominal visceral structures or gas on CXR, CT or contrast studies will confirm the diagnosis. The initial operative approach is laparotomy but thoracotomy must be considered as abdominal viscera may be adherent to thoracic structures.