Delayed Presentation of Diaphragmatic Rupture Following Blunt Trauma in View of Critical Circumstances at Admission (original) (raw)
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Case Reports in Clinical Practice, 2021
Traumatic Diaphragmatic Rupture (TDR) is a rare type of trauma. Small intestine injuries are the third most common type of injury resulting from blunt trauma to abdominal organs. The immediate diagnosis of TDR and bowel injuries is a daunting task. We reported a 53-year-old male patient who was transferred to the hospital by EMS because of a car accident. The chest X-ray showed the left diaphragm elevation. Also, a computed tomography scan revealed that the greater omentum, a portion of the colon, spleen, and stomach were transposed in the hemithorax through a diaphragm rupture. The patient underwent laparotomy and the incidental findings in laparotomy showed bowel injuries. This case was a common cause of traumatic left-sided diaphragmatic rupture and intestinal injury. The suspicion of diaphragmatic rupture and intestinal injury in a patient with multiple traumas contributes to early diagnosis. Surgical repair remains the only treatment for diaphragmatic rupture. The severe injury...
Journal of Medical Case Reports, 2010
INTRODUCTION: Traumatic diaphragmatic hernias are an unusual presentation of trauma, and are observed in about 10% of diaphragmatic injuries. The diagnosis is often missed because of non-specific clinical signs, and the absence of additional intra-abdominal and thoracic injuries. CASE PRESENTATION: We report a case of a 59-year-old Italian man hospitalized for abdominal pain and vomiting. His medical history included a
Case Reports in Pulmonology, 2013
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.
Delayed diagnosis of traumatic diaphragmatic hernia may cause colonic perforation: a case report
Cases Journal, 2009
Early diagnosis of diaphragmatic rupture after traumas may be difficult, and delayed diagnosis may result in increased morbidity and mortality. This paper describes the case of a 32-year-old man who experienced a traffic accident and had diagnosis of traumatic diaphragmatic hernia nearly four months later. The patient was referred to our emergency room suffering from ileus symptoms. Physical examination demonstrated an apparent abdominal distention, tenderness at the upper abdominal quadrants, rebound, and defense. Thoraco-abdominal X-rays and computerized tomography imaging demonstrated intestinal segments with air-fluid levels in thorax. Laparotomy was performed after a preoperative diagnosis of a strangulated-diaphragmatic hernia. At abdominal exploration, it was found that transverse colon and omentum entered into thorax through diaphragmatic defect located at the left diaphragm. Herniating colon segment was complicated with ischemic necrosis and perforation. In conclusion, colon necrosis and perforation may develop when early diagnosis of diaphragmatic ruptures are missed.
International Surgery Journal
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.
CJEM, 2004
Rupture of the diaphragm is almost always due to major trauma and is most commonly associated with road-traffic accidents. We report a case of delayed presentation of a 35-year-old woman with a ruptured diaphragm, 11 days following apparent minor blunt trauma. This case illustrates how the diagnosis of ruptured diaphragm can be missed and demonstrates the importance of considering this diagnosis in all cases of blunt trauma to the trunk. It also demonstrates the potential pitfall of misinterpreting the chest radiograph, and the value of repeat imaging after insertion of a nasogastric tube.
Traumatic Diaphragmatic Rupture – A Clinical Experience Over Two Decades
International Journal of Contemporary Medical Research [IJCMR], 2019
Introduction: Traumatic diaphragmatic rupture was once only reported in post mortem findings. But due to better advanced trauma and life support services and increased survival of the trauma patients, these are now diagnosed with increasing frequency. The purpose of this study was to present our experience with its different mechanisms of rupture and its management. The aim of this retrospective study was to evaluate manifestations of effects of diaphragmatic rupture after thoraco-abdominal trauma, and to discuss their epidemiology, diagnosis, nature and treatment with an aim to impart comprehensive timely management to reduce morbidity and mortality. Material and methods: It is the report of combined experience of the authors on 18 patients with traumatic diaphragmatic rupture with (TDR) or without traumatic diaphragmatic hernia (TDH) treated in two Medical College Hospitals in Kolkata, from 1998 to 2019, and a retrospective analysis was performed. 9 patients who presented with severe injury with features of internal injury were operated early and 9 with non severe injury were operated later. Results: Out of 18 patients, 14 had history of blunt trauma and 4 had history of penetrating trauma. 4 patients with penetrating together with 5 with blunt injury were included in the severe group and had undergone early surgery due to suspected internal injuries. Out of these 9 patients, 5 patients having TDR and 1 having TDH died due hemorrhage and / or sepsis with a mortality of 33.33. TDH was diagnosed by imaging studies in 9 patients in non severe group while 1 was diagnosed intra operatively in the severe group. Conclusions: Though priority of a blunt or a penetrating trauma patient involves resuscitation and early surgery when indicated, careful understanding of mechanism of injury can guide the emergency surgeon to suspect and examine the diaphragm for any TDR to prevent further complication. In addition to X rays computer tomographic study when available becomes helpful in preoperative planning of surgery for closure of TDR or TDH.
Late presentation of blunt right diaphragmatic rupture (hepatic hernia
American Journal of Emergency Medicine, 2008
Diaphragmatic rupture occurs in 0.8% to 3.6% of patients after blunt or penetrating thoracoabdominal trauma, and the preoperative diagnosis is difficult. The diagnosis of traumatic diaphragmatic rupture may be made on initial presentation or at any time later. Right-sided diaphragmatic rupture is rare and occurs in approximately 5% to 20% of all diaphragmatic disruptions. The incidence of herniation of the intra-abdominal organs into the pleural cavity is also low, observed in only about 19% of right-sided diaphragmatic ruptures. We present a case of right-sided traumatic rupture of the diaphragm diagnosed 15 years after the initial blunt trauma. A 22-year-old male patient fell 15 years before and was symptom-free since then. He was referred to our hospital with the signs of herniation of the right diaphragm, which was manifested in the chest x-rays. The definite diagnosis was made through thoracoabdominal computed tomography. The diaphragmatic rupture was repaired via abdominal approach. 0735-6757/$see front matter
Traumatic diaphragmatic hernia
Indian Journal of Surgery, 2008
Background Abdominal trauma is frequently encountered, but traumatic injuries to the diaphragm are often missed. Material and methods A retrospective review of all the case fi les of patients presenting with traumatic diaphragmatic injury was performed. These patients were analyzed for their presentation, injury, surgery performed and outcome Results A total of 14 patients were thus identifi ed (12 males and 2 females). The average age was 31.5 years. Road traffi c accidents were the most common cause, accounting for the majority of cases (12 patients). 10 patients presented within 24 hours of injury; the other 4 presented late (2½ months to 20 years) with the signs and symptoms of acute intestinal obstruction. The left side of the diaphragm was injured more commonly. Herniation of multiple intra abdominal viscera was common, with the stomach being the organ most commonly implicated. There were 2 deaths. Conclusions Traumatic injury to the diaphragm must be kept in mind while dealing with patients who have sustained abdominal trauma. The diagnosis can easily be picked up on chest x-ray. Treatment is surgical, with simple suturing of the diaphragm with non-absorbable suture giving good result