Traumatic Diaphragmatic Injury Research Articles

Laparoscopic repair of a traumatic diaphragmatic hernia with repeated colon incarcerations 7 years after injury: a case report

BackgroundA diaphragmatic hernia is a prolapse of the abdominal organs into the thoracic cavity through a hole in the diaphragm. Traumatic diaphragmatic injuries are rare and usually occur after blunt or penetrating thoracic or abdominal traumas. Blunt diaphragmatic rupture rarely accounts for immediate mortality and may go clinically silent until complications occur which can be life threatening. It usually present late with intrathoracic herniation of abdominal viscera and carry a high mortality rate. We experienced a very rare case who showed repeated colon incarcerations 7 years after injury. And, we operated laparoscopically.Case presentationA 64-year-old man presented with multiple left rib fractures that occurred during an accident. After 7 years, he visited the emergency department with the chief complaint of left shoulder pain and epicardial pain after eating. He was diagnosed with transverse colon incarceration due to a left diaphragmatic hernia by computed tomography (CT) and X-ray imaging. Surgical repair was recommended, but he refused as the symptoms improved. Fourteen months later, the patient revisited the hospital in similar symptoms and improved spontaneously. He consulted our hospital for the surgical indication. We recommended that he undergo surgery, showing images of the X-ray and CT when his transverse colon was obstructed and he felt pain and when symptoms improved. Finally, he decided to undergo surgery. We performed diaphragmatic hernia repair with laparoscopic direct suturing in good view. The patient experienced an uneventful postoperative recovery period. The absence of diaphragmatic herniation recurrence was confirmed seven months after surgery.ConclusionsWe experienced a traumatic diaphragmatic hernia with repeated colon incarcerations 7 years after injury and performed surgical repair laparoscopically.

Incidence of Traumatic Diaphragmatic Injury: Results From a Retrospective Cohort Study in a Level I Trauma Center in Riyadh.

Introduction Traumatic diaphragmatic injuries (TDIs) are uncommon and the incidence of TDIis difficult to estimate because of the variation in reporting missed or late detected diaphragmatic injuries.Therefore, our study's aim was to investigate the prevalence of traumatic diaphragmatic injury in the thoracoabdominal trauma, discuss the etiological factors, diagnostic investigations, and outcomes in TDIs, andevaluate predictors of mortality in patients who were diagnosed at King Abdulaziz Medical City in Riyadh, Saudi Arabia. Materials and methods This observational retrospective cohort study was conducted at King Abdulaziz Medical City (KAMC), a tertiary hospital in Riyadh, Saudi Arabia. The study included all adult patients aged 18 years or older diagnosed with traumatic diaphragmatic injuries between the years 2016 and 2020.The BESTCare electronic system was used to get the patient'smedical records and extract the data.Pearson χ2 test was used for categorical variables, and an independent t-test was used for continuous variables to investigate the association between predictors and outcomes. Results A total of eight patients were involved in this study. The mean age of the patients was 49 years old. Males outnumbered females by 75%. Patients admitted with blunt injuries were greater by 75% compared to penetrating injuries by 25%.The left side of the diaphragm was the most common site of injury.The total number of patients who were admitted to the ICU was five, four of whom had blunt trauma and one had a penetrating injury. Conclusion The demographic data of the patients included in this study corresponded to that in the literature. Although not reaching a statistically significant level, ICU admissions and mortality were mostly associated with blunt injuries.Larger multi-centerstudies are required to further investigate the incidence of traumatic diaphragmatic injuries (TDI).

Analysis of traumatic acute diaphragmatic injuries.

Diaphragm rupture (DR) is a rare pathological event usually caused by trauma. We aimed to analyse the characteristics of acute diaphragmatic injuries due to trauma and the treatment of such injuries. This study included the data of 15 patients who sustained diaphragmatic injuries due to trauma and underwent surgery at the Diyarbakır Gazi Yaşargil Training and Research Hospital General Surgery Service between January 2016 and December 2019. There were 240 patients who presented with abdominal trauma during the study period, and DR was detected in 15 (6.25%) of these patients. The male to female ratio was 14 to 1, and the average age of the patients was 29.66 ± 10.56 (15-46) years. The most common cause of diaphragmatic injury was penetrating abdominal injuries (86.7%). Blunt abdominal trauma accounted for 13.3% of the DR cases. Preoperative shock was present in four (26.7%) patients. Preoperative diagnosis was made in only one (6.7%) of 15 patients with DR. Other patients were diagnosed during operation. Thirteen (86.7%) patients had additional organ injuries, and two patients had isolated diaphragmatic injuries. The most frequently injured organ was the lung (n = 7, 46.6%). Complications developed in six patients (morbidity rate 40%), and pulmonary complications were most frequently encountered (n = 5, 33.3%). The mortality rate was 6.7%. As traumatic DRs are uncommon and often associated with additional organ injuries, a careful general assessment of the patient should be made.

Mınımum Nassıve Approach to Post-Traumıc Dıaphragm Injury

Objectıves: Diaphragm injury is mostly caused by blunt or penetrating trauma. It is a rare diagnosis and therefore carries a risk of misdiagnosis or delay in diagnosis. We perform routine thoracoscopy for the treatment of patients with traumatic rib fractures in our institution. We recorded several cases of occult diaphragmatic injuries and hypothesized that these injuries may be a penetrating injury from rib fractures, as opposed to the high-velocity blunt trauma typically associated with diaphragmatic injuries. Methods: The medical records of all patients admitted to our Şişli etfal hamdiye hospital with rib fractures and traumatic diaphragmatic injuries between January 2012 and January 2023 were retrospectively reviewed.

Twenty-year perspective on blunt traumatic diaphragmatic injury in level 1 trauma centre: Early versus delayed diagnosis injury patterns and outcomes.

Blunt traumatic diaphragmatic injury (TDI) is typically associated with severe trauma and concomitant injuries. It is a diagnostic challenge in the setting of blunt trauma and can be easily overlooked especially in the acute phase often dominated by concurrent injuries. A retrospective review was conducted of patients with blunt-TDI identified from a level 1 trauma registry. Variables associated with early versus delayed diagnosis as well as non-survivor and survivor groups were collected to examine factors associated with delayed diagnosis. A total of 155 patients were included (mean age 46 ± 20, 60.6% male). Diagnosis was made <24 h in 126 (81.3%), and >24 h in 29 (18.7%). Of the delayed diagnosis group, 14 (48%) were diagnosed >7 days. Overall, 27 (21.4%) patients had a diagnostic initial CXR and 64 (50.8%) had a diagnostic initial CT. Fifty-eight (37.4%) patients were diagnosed intraoperatively. Of the delayed diagnosis group, 22 (75.9%) had no initial signs on CXR or CT, 15 (52%) of this group had persistent pleural-effusions/elevated-hemidiaphragm leading to further investigation and diagnosis. No significant difference in survival was observed between early and delayed diagnoses, no clinically significant injury patterns to predict delayed diagnoses were noted. The diagnosis of TDI is challenging. Without frank signs of herniation of abdominal contents on CXR or CT, the diagnosis is often not made on initial imaging. In patients with the evidence of blunt traumatic injury in the lower-chest/upper-abdomen, a high degree of clinical suspicion should be held and follow-up CXRs/CTs arranged.

The edemiological state of blunt diaphragmatic injury: An analysis of a nationwide trauma registry in Japan

BackgroundLittle is known about blunt traumatic diaphragmatic injury (BTDI). This study aimed to investigate the epidemiological state of BTDI, using a nationwide trauma registry in Japan. MethodsData of patients aged ≥18 years who experienced blunt injury between January 2004 and May 2019 were extracted from the Japan Trauma Data Bank. Demographics, cause of trauma, mechanism of injury, physiological parameters, organ injuries, and bone fractures were compared between patients with and those without BTDI. Multivariable logistic regression analysis was performed to identify factors associated with BTDI. ResultsA total of 305,141 patients from 244 hospitals were analyzed. The median patient age (interquartile range) was 65 (44–79) years, and 185,750 (60.9%) were men. BTDI was diagnosed in 868 patients (0.3%). The prevalence of BTDI was stable, between 0.2 and 0.6%, over the study period. Among the 868 patients with BTDI, 408 (47.0%) fatalities were recorded. Mortality rates in each year were 42.5–68.2%, with no significant trend toward an improved outcome (P = 0.925). Our multivariable logistic regression analysis found that mechanism of injury, Glasgow Coma Scale score (9–12 or 3–8) on hospital arrival, hypotension (systolic blood pressure <90 mmHg) on hospital arrival, organ injuries (lung, heart, spleen, bladder, kidney, pancreas, stomach, and liver), and bone fractures (rib, pelvis, lumbar spine, and upper extremities) were independently associated with BTDI. ConclusionUsing a nationwide trauma registry, this study revealed the epidemiological state of BTDI in Japan. BTDI was found to be a very rare but devastating injury, with high in-hospital mortality. Some clinical factors, such as mechanism of injury, Glasgow Coma Scale score, organ injuries, and bone fractures, were independently associated with BTDI.

Post-traumatic giant thrombosis of inferior vena cava induced right-sided blunt traumatic diaphragmatic injury: a case report

BackgroundInferior vena cava thrombosis is a severe disease as it carries a higher risk of developing pulmonary embolism associated with a high mortality rate. The incidence of inferior vena cava thrombosis is extremely low and is commonly associated with outflow obstruction of the inferior vena cava. The frequency of traumatic diaphragmatic injuries is less than 1% of all traumatic injuries. In addition, it was not a typical cause of inferior vena cava obstruction. We report the case of the patient who presented with giant thrombosis of the inferior vena cava, which required surgical treatment-induced right-sided blunt traumatic diaphragmatic injury.Case presentationA 60-year-old male presented to the emergency department with pelvic and lower leg pain. He was working on a dump truck with the bed raised position. Suddenly, the bed came down, and his body was crushed and injured. Primary CT showed a right lung contusion and elevation of the right diaphragm but no apparent liver injury. The right pleural effusion gradually worsened after admission, as the traumatic diaphragmatic injury was highly suspected. Repeat CT showed aggravation of elevation of the right-sided diaphragm, narrowing of the inferior hepatic vena cava due to left cephalic deviation of the liver, and formation of a giant thrombus in the inferior vena cava. No adverse hemodynamic effects were observed due to thrombus formation, and we performed thrombolytic therapy. The day after starting thrombolytic therapy, the patient developed pulmonary embolism due to a dropped in SpO2 needed oxygen, and dyspnea triggered by coughing. Thrombolytic therapy was continued after the diagnosis of pulmonary embolism. However, thrombolytic therapy was ineffective, so we decided on surgical thrombectomy and inferior vena cava filter placement. The postoperative course was not eventful, and an anticoagulant was started. The patient was transferred to the hospital on the 62nd day for rehabilitation.ConclusionsWhen a diaphragmatic hernia is suspected of causing hepatic hernia and narrowing of the inferior vena cava, it may be necessary to consider emergency surgical treatment to prevent secondary inferior vena cava thrombosis and fatal pulmonary embolism.

VATS VERSUS LAPAROSCOPY TRAUMATIC DIAPHRAGMATIC INJURY REPAIR

Introduction:Diaphragmatic injury is usually missed in case of trauma patient, clinical picture is usually masked by other abdominal or thoracic injuries. CXR (chest X ray), abdominal ultrasound have a high rate of missing. High index of suspicion is required to diagnose diaphragmatic injury. Discussion:Comparison between 20 cases of traumatic diaphragmatic injury. Surgery is the only treatment. Different approaches are used, taking advantage of the wide spread practice of minimal invasive surgeryVATS (Video assisted thoracoscopic surgey) and laparoscopy. Overlooked injuries are usually on the right side and after blunt trauma in these cases open surgery is favoured.Prolene stitch repair (primary repair) was the main modality of repair, mesh repair was used in larger tears with poor quality tissues .Quality of life improves remarkably after repair with most patients discharged from hospital within few days. Conclusion:VATS and Laparoscopy show efficiency in both diagnosis and treatment of diaphragmatic injuries. Conversion to open surgery may be needed in case of severe visceral injuries.Combined approach needs good communication between thoracic and general surgeonsOutcome is usually favourable with competent long term repair. Uunfavourable outcome is associated with multiple visceral organ injury and critical pre operative status.

Prognosis of Traumatic Diaphragmatic Injury in Dhaka Medical College Hospital, Dhaka

Introduction: Diaphragmatic injuries include wounds and diaphragmatic ruptures due to thoracoabdominal blunt or penetrating trauma. Their incidence ranges between 8 and 15%. The diagnosis is often delayed despite several medical imaging techniques. The mortality is mainly related associate Injury. Aims: The aim of our study was to evaluate the prognosis, after surgery of our patient with diaphragmatic injury. Patients and methods: We performed a prospective study over a period of two years, between January 2018 December 2019, at the department of thoracic surgery of Dhaka Medical College Hospital, Dhaka, Bangladesh. All patients diagnosed with diaphragmatic injury were included in this study. Each patient operated because traumatic diaphragmatic injury was evaluated in respect of age, sex, nature of injury, preoperative examination findings, laboratory test results, imaging methods, time of diagnosis, operation findings, concomitant injures to other organs, operations performed, length of stay in hospital and development of postoperative morbidity and mortality. Results: Over the study period, 22 cases of diaphragmatic injuries were included. The female was 4 and 18 was male. The mean age of male patients 29.2±12.1 and female 28±11.6 years. RTA with blunt trauma chest was 12, 6 was fall from height and 5 were stab injuries. The most common injuries concomitant to traumatic diaphragmatic rupture were a haemothorax, rib fracture, stomach, colon, liver and spleen. Three patients developed wound infection and two patients died. Conclusion: In high energy blunt and penetrating thoracoabdominal trauma, diaphragmatic injures should be suspected. An emergency thoracotomy or laparotomy followed by reposition of abdominal organ and repair of the defect of the diaphragm is the gold standard for the management of these cases. J Dhaka Med Coll. 2021; 30(2) : 131-135

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.

Is diagnostic laparoscopy necessary in the management of left thoracoabdominal stab wounds?

The diagnosis of a diaphragmatic rupture and the identification of patients for surgical repair is challenging despite current diagnostic algorithms and imaging technologies. Unless treated on time, acute traumatic diaphragmatic injury due to stab wounds has a high mortality and morbidity rate, with an increasing trend in the presence of organ herniation. In this study, we aimed to investigate the efficacy of diagnostic laparoscopy in patients with an anterior thoracoabdominal stab wound and to compare the follow-up outcomes of cases. We retrospectively reviewed our institutional database of patients who were admitted with stab wounds between Oc-tober 2012 and 2022. Patients who underwent diagnostic laparoscopy were divided into two groups depending on the presence of a diaphragmatic injury. We analyzed demographics, the success of computed tomography (CT) imaging in the diagnosis, the presence of hemomediastinum, pneumomediastinum, tube thoracostomy application, associated organ injury, type of surgery, duration of surgery, complications, and the length of stay between the groups. Of the 39 patients with penetrating left thoracoabdominal injury underwent diagnostic laparoscopy, CT had a diagnostic sensitivity of 63.16% (95% Confidence interval [CI] 38.36-83.71%), and a specificity of 100% (95% CI 82.35-100.00%). We could not find a statistically significant difference between the groups in terms of studied variables, while operation time was significantly higher in the diaphragmatic injury group (P<0.01). Fourteen patients had accompanied visceral injuries. Diagnostic laparoscopy is still the gold standard particularly in the ER setting, particularly in the absence of an experienced radiologist for 24 h and when the close monitoring of the patient by the same team cannot be provided.

Fecopneumothorax Secondary to a Late Traumatic Diaphragmatic Injury

Traumatic diaphragmatic hernias were first described by Ambroise Paré in 1579, who reported the case of an artillery captain, that presented an intestinal perforation that had caused a diaphragmatic hernia 1. The timely diagnosis of a traumatic diaphragmatic hernia can be a challenge , which requires extensive knowledge of the kinematics of trauma, as well as clinical and radiological evidence 2. We present the case of a 60-year-old male who presented blunt abdominal trauma due to a traffic accident, causing an undetected diaphragmatic hernia in his initial evaluation; months after de incident goes to the emergency room (ER) with hemodynamic instability and septic shock. A diagnosis of complicated diaphragmatic hernia and fecopneumothorax is made, for which he undergoes surgery.

Diaphragmatic Stab Lesion in a 3-Year-Old Girl - The Importance of Prompt Diagnosis and Prevention

Traumatic diaphragmatic injuries are rare, easily missed and require prompt diagnosis and intervention. With this case, the authors highlight, not only the importance of keeping a high level of suspicious for this conditions, but also of preventing these events.

Misery due to missed injuries

Missed injuries and delayed diagnosis are still common problems in the treatment of trauma patients especially, polytrauma. Diaphragmatic injuries are quite common and one of the most important missed injuries. It can result from either blunt or penetrating trauma. Traumatic diaphragmatic injuries (TDI) may go unnoticed initially and later present as life-threatening conditions. Here we present such a case of a fatal diaphragmatic injury, which was diagnosed during the autopsy.

Traumatic Diaphragmatic Injuries at Medicolegal Autopsy: A 1-Year Prospective Study.

Traumatic diaphragmatic injuries (TDIs) are relatively rare. The forensic literature pertaining to TDIs consists mainly of case studies, suggesting little attention to these injuries during autopsies and research. This prospective study was conducted at the Ga-Rankuwa Forensic Pathology Services mortuary over a 1-year period. We included all cases who had a full medicolegal autopsy, as prescribed by the relevant South African legislation (Inquest Act 58 of 1959). All diaphragms were examined by a forensic medical practitioner performing the autopsy. Nine hundred ninety-nine cases were analyzed; of these, 71 cases with TDIs were identified. The incidence of TDI was, therefore, determined to be 7.11%. A total of 60.56% involved the right hemidiaphragm, 19.72% the left hemidiaphragm, and 19.72% were present bilaterally. A total of 85.92% were present in men and 14.08% in women. Blunt force trauma comprised 33.80%, and penetrative trauma 61.97%. Most were associated with severe injuries. A total of 12.68% had organ herniation through the defects present. Our study revealed that TDIs were more common than initially reported. The right side was more often involved in our study than in other studies. Diaphragmatic injuries were observed in 21.46% of all penetrative trauma cases received in a year.

Successful laparoscopic management of an isolated grade four traumatic diaphragmatic injury: A case report

The AMJ is a peer-reviewed, triannual health journal published by Anuradhapura Clinical Society (ACS).The Journal strives to be a forum for all health professionals to publish original research and review articles in their area of expertise. The AMJ publishes articles in clinical medicine, public health and health promotion. Our priority is given to manuscripts on health related issues which affects the communities living in rural tropical communities. Established as a journal in 2006 as a publication parallel to ACS annual scientific sessions, the journal was relaunched as a proper journal in 2013. Anuradhapura Medical Journal is a member of COPE and is included on DOAJ.

A case of traumatic diaphragm injury repaired by video-assisted thoracic surgery

A case of traumatic diaphragm injury repaired by video-assisted thoracic surgery

Laparoscopic repair of acute traumatic diaphragmatic hernia with mesh reinforcement: A case report.

Introduction and importanceTraumatic diaphragmatic injuries are rare and usually occur after thoracoabdominal trauma. Most patients will have other potentially life-threatening injuries. High index of suspicion is the most important attribute. Unfortunately, it is incorrectly diagnosed in up to 33% of cases. If left untreated, the onset of complications carries mortality rates between 25 and 80%.Case presentationWe report a case of an acute diaphragmatic laceration in a 29-year-old male with thoracoabdominal trauma due to a road traffic accident. Physical examination revealed an absence of normal breath sounds in the left hemithorax. CT-scan confirmed a voluminous left diaphragmatic hernia with omental, gastric, and transverse colon content, so surgical intervention was advised. During laparoscopy, a 15 cm long and 5 cm wide diaphragmatic defect was identified. The hernia was reduced laparoscopically, and the defect repaired with interrupted non-absorbable sutures. As a reinforcement, a visceral contact prosthesis was placed. The patient had an uneventful recovery and after 12-month follow-up he has no evidence of recurrence.Clinical discussionDiaphragmatic injuries do not close spontaneously. An abdominal approach is recommended as it allows for evaluation of the entire abdomen and treatment of any associated injury. Watertight closure with nonabsorbable suture and in case of large defects, the placement of a mesh on the peritoneal side of the diaphragm is recommended to reinforce the primary repair.ConclusionLaparoscopic emergency surgery has proved to be effective and safe in selected patients with hemodynamic stability. Patients can expect the benefits of minimal invasive surgery with recurrence rate like the open approach.

Diaphragmatic injury in trauma: an entity that may be unnoticed

Background: Traumatic diaphragmatic injuries are rare, but their incidence has escalated due to the increase in traffic accidents and cases of urban violence. This pathology can be unnoticed under many circumstances, so a high level of suspicion is required to establish an early diagnosis and to prevent life-threatening complications. Case presentation: A 43-year-old male patient who is found in public street presenting a generally poor condition, with stigmata of trauma in the right frontotemporal region, deformity in the right humerus, multiple excoriations caused by friction, presumed to have suffered a traffic accident. The thorax was found with no deformities, no bone crepitus, and no signs of breathing difficulty. Discusion and literature review: Based on the injury mechanism, diaphragmatic trauma can be classified as blunt and penetrating trauma, attributing approximately two-thirds of cases to penetrating trauma (gunshots, stab wounds) and one-third to blunt trauma (car accident). The injured diaphragm presents a solution of continuity whose healing does not occur spontaneously and in the course of its evolution, migration from the abdominal organs to the pleural cavity may occur. The initial study in patients with suspected diaphragmatic lesion is usually a chest X-ray with diagnostic sensitivity in left-sided lesions ranging from 27%-62%, and for right-sided lesions, it is 17%-33%. Suggestive findings of diaphragmatic lesion include the collar sign (compression of the herniated organ at the point of the diaphragmatic lesion), bowel loops within the chest, arcing shadows in the left hemithorax, and the presence of the gastric chamber in the chest. Computed tomography is the study of choice in the polytraumatized patient for the evaluation of abdominal and thoracic trauma, due to its high sensitivity and specificity in the diagnosis of associated lesions.

A Retrospective Study of Traumatic Diaphragmatic Hernia in Rajasthan

Introduction: Diaphragmatic injuries occur in 3.9 % of chest injuries. Traumatic diaphragmatic hernia usually undergo unrecognized. Diagnosis of diaphragmatic injuries is usually difficult. Materials and Methods: The records of patients who got operated for traumatic diaphragmatic hernia in the Department of Cardio- Thoracic and Vascular Surgery at SMS Hospital, Jaipur between July 2012 to July 2019 were referred. 39 patients underwent surgery for diaphragmatic hernia. From records history, age, sex, symptoms, signs, chest X-ray finding, operative approach for repair, operative course and outcome were recorded. Results: From 2012 July to 2019 July, 39 patients were operated by thoracotomy for traumatic diaphragmatic injury of which 29 were males and 10 were females. The oldest patient was 60 years old and the youngest was 12 years old. The cause of rupture of diaphragm was blunt abdominal trauma in 30 cases, penetrating chest trauma was seen in 9 cases. 33 cases gave history of road traffic accidents, 6 had fallen from height. Left sided tear was seen in 35 cases whereas 4 patients had right sided rupture. Most common symptom was difficulty in breathing seen in 34 cases. Reduced air entry was seen in 39 cases. The diagnosis of diaphragmatic hernia was made on the basis of history, clinical examination of chest X-ray with ryles tube in situ in 36 cases, whereas 3 case required CECT. Conclusion: Traumatic diaphragmatic hernia requires high index of suspicion for diagnosis, investigation most commonly chest x ray with ryles tube. It is more common in males and usually left sided. Early and prompt surgical repair by thoracotomy is the treatment of choice. The following core competencies are addressed in this article: Patient care and Procedural skills, Medical knowledge, and System-based practice.