Laparoscopic repair of penetrating injury of the diaphragm: an experience from a district hospital (original) (raw)
Related papers
Penetrating Diaphragmatic Injury: A Lesson Learnt After Laparotomy
The Internet Journal of Surgery, 2013
Traumatic diaphragmatic injuries still are difficult to diagnose; it needs a high index of suspicion in patients having severe thoracoabdominal blunt or penetrating trauma. To diagnose them accurately, poses a challenge to trauma surgeons, especially in cases of small injuries, which later may be diagnosed as diaphragmatic hernias, and their complications. An emergency laparotomy followed by repair of the defect is gold standard in the management of these patients. Herein, we report a case of penetrating diaphragmatic injury in a young female having multiple stab wounds on the left side of the chest and the abdomen with a chest x-ray showing air under the right dome of the diaphragm.
Successful Laparoscopic Repair of Posttraumatic Diaphragmatic Injury
Cureus, 2020
Diaphragmatic injuries can be a direct result of penetrating thoracoabdominal trauma such as gunshot or stab wounds. Diaphragmatic rupture can lead to herniation of intra-abdominal organs into the thoracic cavity. Diagnosis can be difficult as the results of a physical exam can be unremarkable. A CT scan of the chest is diagnostic for diaphragmatic injuries. In most emergency cases, diaphragmatic injuries are managed with laparotomy where CT was diagnostic. We report a rare case of a 25-year-old man with right diaphragmatic injury sustained after a stab wound to the right liver managed successfully with laparoscopy.
Occult Diaphragmatic Injuries Caused by Stab Wounds
The Journal of Trauma: Injury, Infection, and Critical Care, 2003
Background: Missed diaphragmatic perforation caused by penetrating trauma can lead to subsequent strangulation of a hollow viscus, which has prompted the use of invasive diagnostic procedures to exclude occult diaphragmatic injuries in asymptomatic, high-risk patients. The objective of this study was to determine the incidence of occult diaphragmatic injuries caused by stab wounds of the lower chest and upper abdomen, and to examine the natural history and consequences of missed diaphragmatic injuries. Methods: On the basis of patient data from two previous randomized studies from our institution, a retrospective analysis was performed on 97 patients treated for anterior stab wounds located between the nipple line, the umbilical level, and the posterior axillary lines not having indications for immediate surgical exploration. The patients were divided into two groups on the basis of their initial randomized management (open or laparoscopic exploration vs. expectant observation). Results: In the exploration group (n ؍ 47), four diaphragmatic injuries (9%) were detected (three left-sided and one right-sided). Excluding patients with associated injuries requiring surgical repair, the incidence of occult diaphragmatic injuries was 3 of 43 (7%). In the observation group (n ؍ 50), there were two patients (4%) with delayed presentation of missed left-sided diaphragmatic injury 2 and 23 months later, respectively. Both injuries resulted from stab wounds of the left flank and presented with herniation of the stomach or small bowel and colon. The overall incidence of occult diaphragmatic injuries in left-sided thoracoabdominal stab wounds was 4 of 24 (17%), and was much lower after stab wounds of left epigastrium (0%), right lower chest (0%), and right epigastrium (4%). Conclusion: In asymptomatic patients with anterior or flank stab wounds of the lower chest or upper abdominal area, the risk of an occult diaphragmatic injury is approximately 7% which, if undetected, is associated with a high risk of subsequent hollow viscus herniation. Exclusion of an occult diaphragmatic injury with invasive diagnostic methods, such as laparoscopy or thoracoscopy, should be considered at least in left-sided stab wounds of the lower chest.
Laparoscopic Management of Left Thoracoabdominal Stab Wounds: A Prospective Study
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2010
Background: Left thoracoabdominal stab wounds (LTSWs) leading to diaphragmatic injuries can cause serious morbidity and mortality. The diagnosis and treatment of LTSWs are controversial. This study investigated the reliability of laparoscopy for the diagnosis and treatment of diaphragmatic lacerations in hemodynamically stable patients with an LTSW, hypothesizing that laparoscopy is sufficient for diagnosing and treating diaphragmatic injury after an LTSW.
South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie, 2017
The purpose of this study was to determine whether patients with left-sided thoracoabdominal (TA) stab wounds can be safely treated with clinical and chest X-ray follow up. A prospective, randomized control study was conducted at Groote Schuur Hospital from September 2009 through to November 2014. Patients with asymptomatic left TA stab wounds included in the trial were randomized into two groups. Group A underwent diagnostic laparoscopy and Group B underwent clinical and radiological follow-up. Twenty-seven patients were randomized to Group A (N=27) and thirty-one to Group B (N=31). All patients were young males with a median age of 26 years (range 18 to 48). The incidence of occult diaphragm injury in Group A was 29%. All diaphragm injuries found at laparoscopy were repaired. The mean hospital stay for the patients in Group A was 5 days (SD 1.3), compared to a mean hospital stay of 2.9 days (SD, 1.5), in Group B (p < 0.001). All patients in Group B had normal chest X-rays at th...
Our Experience of Laparoscopic Surgery in Traumatic Diaphragmatic Injuries
Laparoscopic Endoscopic Surgical Science, 2019
Introduction: Diaphragmatic injuries are rare and occur in about 3% of all abdominal injuries. While 5% are caused by motor vehicle accidents, 10%-15% are caused by penetrating trauma. Diaphragmatic injury develops in 0.8%-7% of blunt trauma cases and 10%-15% of penetrating trauma cases. The aim of this study was to present a report of patients from a single center who underwent laparoscopic repair with the diagnosis of traumatic diaphragmatic injury during a 2-year period. Materials and Methods: Patients who underwent laparoscopic surgery at the study center due to traumatic diaphragmatic injury between May 2017 and November 2018 were included in the study. The demographic characteristics of the patients, cause of injury, additional injured organs, anatomical localization of the injury, surgical procedure, quantity of intraoperative hemorrhage, rate of conversion to open surgery, duration of hospitalization, morbidity and mortality rates, and 30-day readmission rate were retrospectively reviewed using hospital files and electronic records. Results: Of the patients enrolled in the study, 3 were female and 1 was male. The mean age was 47.25 years (range: 36-66 years). The injury etiology was penetrating injury for 3 patients and in-vehicle traffic accident for 1 patient. Two patients had a hemopneumothorax, which was treated with a chest tube. One patient displayed hematoma in the liver and spleen. The injury to the left diaphragm was 1-4 cm in diameter in all of the study patients. A primary repair was performed in all cases. The mean quantity of intra-abdominal bleeding was 212 mL (range: 100-300 mL) and the mean postoperative hospital stay was 7.5 days (range: 5-13 days). A postoperative intra-abdominal abscess developed in 1 patient. There was no instance of mortality and no patient was re-admitted in the 30-day period after discharge. Conclusion: It has been reported in the literature that laparoscopic approaches can be used safely in selected cases of abdominal injury, and can potentially have the benefits of laparoscopy. The results of this study also suggest that laparoscopy can be used safely in cases of traumatic diaphragmatic injury in the appropriate patients.
Laparoscopic Repair of a Ruptured Diaphragm: Avoiding a Trauma Laparotomy
CRSLS: MIS Case Reports from SLS
Background: A traumatic diaphragm rupture presents a unique obstacle to a minimally invasive surgical approach; most repairs are performed during an emergency laparotomy. Diaphragm injuries are diagnosed in the acute phase of blunt-force trauma in only 10% of cases, and a high index of suspicion must be maintained to avoid strangulation of the abdominal organs that have herniated into the thoracic cavity. A laparoscopic evaluation and repair of an acute blunt-force rupture of the diaphragm can be diagnostic and curative, mimicking the outcome of an open procedure. Case Description: A 23-year-old woman had a left-side blunt-force rupture of the diaphragm sustained in a high-impact motor vehicle collision. The focused assessment with sonography for trauma (FAST) was negative. The survey chest radiograph identified only streaky opacities that were read as atelectasis. Computed tomography of the abdomen revealed the presence of a congenital abnormality versus a ruptured diaphragm. A diagnostic trauma laparoscopy was performed to evaluate for the possibility of a left-side rupture, and at that point, the spleen and the stomach were found to be located in the left chest, herniating through a rupture in the left diaphragm. A grade I splenic laceration was present. The abdominal structures were reduced and the traumatic rupture was successfully repaired laparoscopically. Discussion: Traumatic rupture of the left diaphragm can occur as an occult injury after blunt-force trauma to the torso. The liver lends protection to the diaphragm and a right-side rupture is far less common than one on the left side. The initial diagnostic plain chest x-ray may not reveal the tear in the diaphragm and the herniation of abdominal viscera into the thoracic cavity. Laparoscopy has been used to evaluate the possibility of a rent in the diaphragm when the patient is hemodynamically stable and the diagnosis is uncertain. Although initial laparoscopic or thorascopic evaluation of a potential rupture of the diaphragm is the standard of care in the trauma literature, laparoscopic repair is not widely accepted. However, laparoscopic evaluation of acute torso trauma with reduction of abdominal viscera and subsequent laparoscopic repair of the diaphragm can be successful.
International Journal of Surgery Case Reports, 2021
INTRODUCTION: Diaphragmatic rupture is an uncommon trauma complication and it is associated with chronic diaphragmatic herniation, especially in the left side. Chronic diaphragmatic herniation is usually due to white weapon injury and as consequence of low suspicious and absence of proper investigation. CASE REPORT: We report a chronic diaphragmatic herniation after three years of a stab in the left thoracoabdominal transition, managed through laparotomy. DISCUSSION: Traumatic diaphragmatic rupture is a rare trauma consequence, most common in the left side. The herniation occurs gradually because of negative pressure of the thoracic cavity that works as a suction of the abdominal organs. CONCLUSION: Traumatic diaphragmatic ruptures diagnosis is difficult and might go unnoticed without high suspicious and proper investigation. Chronic herniation is associated with higher morbimortality.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2009
Management of posttraumatic diaphragmatic injury (DI) is still challenging. In suspected patients with stable hemodynamic, laparoscopy may aid in the diagnosis and treatment of DI. To analyze and determine the role of laparosocopy in diagnosis and treatment of suspected diaphragmatic injury patients at Trauma Centre, Faculty of Medicine Siriraj Hospital. A prospective descriptive study was conducted between 2001 and 2008 in Division of Trauma Surgery, Siriraj Hospital, Mahidol University, Thailand. Twenty-four suspected DI patients with stable hemodynamic were reviewed and analyzed Laparoscopy was performed in all patients. Of the patients, 95.8% were men with a mean age of 27.3 years (range, 14-54 yr). Twenty-three patients (95.8%) had a penetrating injury. Five patients (20.8%) presented with tachypnea and decreased breath sound Pneumohemothorax occurred in five patients (20.8%). Chest x-ray revealed diaphragmatic elevation in one patient (4.2%). Five cases (20.8%) were found DI. ...