Delayed presentation of traumatic diaphragmatic rupture with. Traumatic diaphragmatic rupture tdr is an uncommon entity estimated to have an incidence of 0. Traumatic diaphragmatic hernia is a rare and often under. The diagnosis can be difficult to make as the physical examination may be unremarkable, and imaging, that is, a conventional chest xray andor ct imaging, may initially fail to reveal the injury. The entity of diaphragmatic rupture posttrauma was first described by sennertus in 1541. A retrospective case note analysis was performed on all patients treated for traumatic diaphragmatic rupture tdr at a major teaching hospital between january 1990 and august 1998. Traumatic diaphragmatic injuries are rare, but potentially life threatening due to herniation of abdominal organs into the pleural.
The experience with traumatic diaphragmatic hernia at the johannesburg general hospital during 195973 is described. Nontraumatic diaphragmatic hernia in adult sushila ladumor1and adham darweesh2 1consultant radiologist, clinical imaging department, hamad medical corporation, hgh, doha, qatar, assistant professor in clinical radiology, weil cornel medical college, qatar wcmcq. If the diagnosis is missed, patients may develop intrathoracic visceral herniation and strangulation, with a morbidity and mortality rate of up to 50%. Traumatic diaphragmatic rupture tdr usually results from blunt or penetrating injuries, and is rarely iatrogenic. Diaphragmatic rupture may occur after blunt or penetration trauma caused by the application of a powerful external force. Multislice ct and magnetic resonance imaging in the preoperative evaluation of trauma. Traumatic diaphragmatic injury department of surgery at. Traumatic rupture of diaphragm the annals of thoracic surgery. Ambroise par6, in 1579, described the first case of diaphragmatic rupture diagnosed at autopsy. Blunt diaphragmatic rupture is an uncommon occurrence.
Shows diaphragmatic discontinuity, herniated organs reveals associated abdominal organ pathologies herniation of vessels from omentum and abdominal organs converging into hernia sac blaivas, m. Traumatic diaphragmatic rupture, a diagnostic dilemma in. Diaphragmatic injuries are quite uncommon and often result from either blunt or penetrating trauma. The article published in chest by seelig and associates january 19991 on a very rare complication of occult diaphrag matic hernia has an important theoretical and practical value. Traumatic rupture of diaphragm the annals of thoracic. We report the case of a patient with blunt trauma with right diaphragmatic rupture that required urgent surgical treatment for hepatothorax and iatrogenic severe liver injury. The left diaphragm is involved more often because of the protective effect of the right lobe of the liver. Diaphragmatic rupture is a lifethreatening condition. Traumatic diaphragmatic hernia has always been a diagnostic challenge to both the radiologist and surgeon. Traumatic diaphragmatic hernia the annals of thoracic surgery.
Like the authors, we found that the diagnosis of blunt trau. When a conservative approach to trauma management is taken, blunt diaphragmatic rupture bdr remains undiagnosed at initial presentation in 7%66% of cases. Traumatic diaphragmatic rupture is a recognized consequence of high velocity blunt trauma to the abdomen usually a result of motor vehicle accident. With delayed treatment, the abdominal organs can move through the new opening into the thoracic cavity, resulting in respiratory compromise and ischemia to the affected abdominal organs.
Evaluation and management of traumatic diaphragmatic injuries. Forty patients with traumatic diaphragmatic rupture with delayed presentation and diagnosis were collected in peking union medical college hospital from 2000 to 2018, and a. Traumatic diaphragmatic rupture remains a diagnostic challenge, and associated injuries determine the outcome in those diagnosed early, whereas that of latent cases is dependent on the consequence of the diaphragmatic rupture. In this study, a total of 68 patients with tdr, were operated in our center between july 1994 and september 2005. The diagnostic and management challenges encountered are discussed, together with strategies for dealing with them. Eventration of the diaphragm is the condition where the muscle is permanently elevated, but retains its continuity and attachments to the costal margins. The incidence rates of traumatic diaphragm rupture is between 0. The patient went to have a successful diaphragmatic repair. Meyers and mccabe 1993 reported that 40% of patients with blunt diaphragmatic injuries present with a pelvic fracture, 25% with liver and spleen injuries, and 5% with thoracic aortic injuries. Rightsided diaphragmatic rupture after blunt trauma. It has been postulated that highvelocity blunt traumatic injuries, particularly motor vehicle collisions, may contribute to blunt diaphragmatic rupture.
Traumatic diaphragmatic rupture tdr is a recognized consequence of high velocity blunt trauma to the abdomen usually a result of motor vehicle accident mva. Majority of injuries tend to present on the left hemidiaphragm but rightsided injuries also occur mostly with subtle, delayed presentation due to the buffering effect of the liver. Diaphragmatic injuries are estimated to occur in 0. Review of literature a pubmed search was conducted using the terms of post traumatic diaphragmatic rupture. Aug 21, 2009 diaphragmatic rupture is a lifethreatening condition.
Diaphragmatic rupture also called diaphragmatic injury or tear is a tear of the diaphragm, the muscle across the bottom of the ribcage that plays a crucial role in respiration. Blunt traumatic diaphragmatic rupture btdr is not an uncommon injury most noteworthy as a marker of severe trauma. The mechanisms responsible for producing diaphragmatic rupture by blunt trauma. It has been reported in upto 5% of thoracoabdominal trauma patients. To investigate the diagnosis and surgical therapy of delayed diaphragmatic rupture. Jan 18, 2011 traumatic injuries of the diaphragm remain an entity of difficult diagnosis despite having been recognised early in the history of surgery, especially when it comes to blunt trauma and injuries of the right diaphragm. Rupture of the diaphragm mostly occurs following major trauma. The true incidence of traumatic diaphragmatic rupture is unknown. In this article, our experience with this challenging diagnosis is presented. Case recurrent diaphragmatic hernia 3 years after initial. Review of literature a pubmed search was conducted using. Recurrent diaphragmatic hernia 3 years after initial repair for traumatic diaphragmatic rupture. Acute traumatic rupture of the diaphragm may go unnoticed and there is often a delay between the injury and the diagnosis.
Traumatic diaphragmatic injury is known to present with the spectrum of symptoms, and most patients would have some symptoms due to abdominal organ herniation. Diaphragmatic rupture can result from blunt or penetrating trauma and occurs in about 5% of cases of severe blunt trauma to the trunk. Traumatic diaphragmatic rupture, a diagnostic dilemma in the. Traumatic diaphragmatic rupture occurs in up to 6% of patients after major blunt trauma. In 14, acute hernias were diagnosed, but the diagnosis was made one month to 15 years after injury in 22 patients with chronic hernia.
Pdf 402 thoracoabdominal traumas have been observed since november 1998 and seven of these patients 1. Blunt trauma in the young male population drivers is the usual cause of traumatic diaphragmatic rupture incidence. Jablonski s, wcislo es, wawrzycki m, misiak p, kordiak j. Erkan akar 1, halil kaya2 1department of thoracic surgery, bursa yuksek ihtisas training and research hospital, bursa, turkey 2department of emergency medicine, bursa yuksek ihtisas training and research hospital, bursa, turkey abstract this study evaluated the demographic and clinical properties, diagnostic and therapeutic approaches. The traumatic diaphragmatic hernia diagnosis is based. Traumatic diaphragmatic rupture was on the left side in 78% of the patients and on the right side in 22%. There have been occasional reports of bilateral injury fig.
Traumatic diaphragmatic hernia is an uncommon, underdiagnosed, and potentially lifethreatening condition with a documented incidence of 6% in cases of blunt trauma. Delayed presentation of traumatic diaphragmatic rupture. Traumatic diaphragmatic hernia occurs in less than 50% of the patients with diaphragmatic injuries. Left kidney and intestinals coils were found to herniate through the diaphragmatic tear. Diagnosis of traumatic diaphragmatic rupture remains a challenge for physicians and most authors suggest the need for a high level of suspicion to identify this lesion. Traumatic diaphragmatic hernia is a fairly rare condition, the diagnosis of which is often missed at the original presentation. Acute traumatic rupture of diaphragm may be unrecognized and there is often a delay between the. Descriptions of recurrent diaphragmatic hernia, especially after repair of traumatic rupture, have been. Jul 01, 2009 blunt traumatic diaphragmatic rupture btdr is not an uncommon injury most noteworthy as a marker of severe trauma.
Traumatic diaphragmatic injuries are rare, but potentially lifethreatening due to herniation of abdominal organs into the pleural. It is a frequently missed diagnosis, and there is commonly a delay between trauma and diagnosis and this is. Diaphragmatic rupture an overview sciencedirect topics. Article traumatic diaphragmatic hernia applied radiology. Most commonly, acquired diaphragmatic tears result from physical trauma.
A diaphragmatic hernia and pericardial rupture caused by. Traumatic diaphragmatic rupture in children sciencedirect. One of the largest contemporary case series of posttraumatic diaphragmatic hernia tdh. The article published in chest by seelig and associates january 19991 on a very rare complication of occult diaphragmatic hernia has an important theoretical and practical value. A traumatic diaphragmatic rupture is a rare, but severe disease that results from blunt or penetrating trauma to the abdomen and chest. Diaphragmatic rupture usually is repaired via laporotomy andor thoracotomy, depending on the associated organ injury. Traumatic diaphragmatic rupture blunt traumatic diaphragmatic rupture is more common on the left side the right hemidiaphragm may be relatively protected from injury due to buffering by the liver delayed presentationmore common on the right side, can lead to complications such as bowel strangulation indicative of a high impact. Chest radiography was the most sensitive diagnostic method 66% for blunt trauma, although other techniques are discussed. Associated abdominal injuries identified at the initial exploration are also addressed at this time. The mechanism of injury is typically a motorvehicle collision. Traumatic diaphragm rupture tdr is a rare complication of trauma in pediatric age and may be easily missed by the severity of associated injuries so that delayed emergent presentation can occur with increased rate of morbidity and mortality. Thoracotomy compared to laparotomy in the traumatic. Preoperative diagnosis of diaphragmatic rupture caused by blunt injury is often difficult because of serious concurrent injuries, a lack of specific clinical signs, and simultaneous lung disease that may mask or mimic the diagnosis radiologically. Diagnosis of traumatic diaphragmatic rupture is often delayed due to lack of pathognomonic symptoms and signs.
Traumatic diaphragmatic hernia can present immediately following injury, but may be overlooked in the urgency to evaluate and treat patients with multiple trauma. Thoracolaparoscopic repair of traumatic diaphragmatic rupture. Note that it has fallen medially and posteriorly to lie against the posteromedial chest wall. Diaphragmatic rupture and its complications following. The leading cause of diaphragmatic rupture is penetrating abdominal trauma, including gunshot and stabrelated wounds. Epidemiology given that the most common mechanism is motor vehicle collisions, it is perhaps unsurprising that youn. Traumatic injuries of the diaphragm remain an entity of difficult diagnosis despite having been recognised early in the history of surgery, especially when it comes to blunt trauma and injuries of the right diaphragm. The dependent viscera sign in ct diagnosis of blunt. Herniation of abdominal organs is present in 34% of people with abdominal trauma who present to a trauma center. Oct 21, 2016 traumatic diaphragm rupture tdr is a rare complication of trauma in pediatric age and may be easily missed by the severity of associated injuries so that delayed emergent presentation can occur with increased rate of morbidity and mortality. The severity of these associated injuries can be assessed via the injury. Traumatic diaphragmatic rupture remains a diagnostic challenge, and associated injuries determine the outcome in those diagnosed early, whereas that of. Given that the most common mechanism is motor vehicle collisions, it is perhaps unsurprising that young men are most frequently affected.
More than 90% of blunt traumatic diaphragmatic ruptures result from motor vehicle accidents, as was the case in this patient. The case of a 49yearold man with traumatic rupture of the left hemidiaphragm is presented. Traumatic diaphragmatic rupture tdr is a rare but potentially life threatening clinical entity with a high incidence of associated injuries. The mechanisms underlying blunt and penetrating diaphragmatic rupture are. Traumatic diaphragmatic rupture tdr occurs in approximately 1% to 7% of patients with major blunt trauma, including in 10% to 15% of patients with trauma that results in penetration of the lower chest. Case report a 16 year old male patient who was involved in a high speed tra. We report a case of delayed presentation of traumatic diaphragmatic hernia on the left side in a 44yearold male who presented two weeks after a minor blunt trauma.
After stabilization, patient was shifted to operation theatre with highrisk consent. Diaphragmatic injury may occur due to both penetrating and blunt trauma. Diaphragmatic rupture leads to a traumatic diaphragmatic hernia 1. Although there is a growing body of literature on tdr, it remains a challenging diagnosis that is difficult to detect on crosssectional imaging 4,5.
Traumatic diaphragmatic injury in the american college of surgeons. A significant complication of diaphragmatic rupture is traumatic diaphragmatic herniation. Plain chest radiograph of diaphragmatic injury with herniation chest radiograph with rupture of the left hemidiaphragm traumatic diaphragmatic hernia on computed tomography diaphragmatic injury with left hemidiaphragm discontinuity traumatic disruption of the diaphragm on plain film and ct. Althogh not encountered in our series, other abnormalities such as diaphragmatic eventration or congenital hernia may give a positive dependent viscera sign in the absence of blunt traumatic diaphragmatic rupture. Tdr is associated with other severe injuries in 44%94% of cases. A traumatic diaphragmatic hernia is caused as a result from blunt or penetrating trauma and occurs in about 5% of cases of severe blunt trauma to the trunk. My experience 34 includes 7 patients who sustained diaphragmatic rupture from blunt trauma over a tenyear period from an emergency ser vice with. Traumatic diaphragmatic hernia jama surgery jama network. Diaphragmatic rupture often results from blunt abdominal trauma. Diaphragmatic ruptures are usually associated with abdominal trauma however, it can occur in isolation. Right axial ct in the same patient shows the typical signs of diaphragmatic injury, including the fallen viscus sign. Latent traumatic diaphragmatic hernia a surgical challenge to the editor. Plain chest radiographs for the diagnosis of posttraumatic.
1301 783 1162 1116 554 727 1432 23 97 725 624 279 642 1027 275 1112 1092 610 680 566 244 444 22 254 671 617 408 980 377 1302 1269 104 550 1074 329 1265 416 1390 174 1277 132 328 636 496 212 1465 1083 1356 43