Hernia, Diaphragmatic, Traumatic :: surgery

Latest Paper:

Kyobu Geka. 2008 May ;61 (5):423-6 18464493 (P,S,G,E,B)

[Cited?]
[Delayed traumatic diaphragmatic hernia with strangulated stomach; report of a case]
Katsuhito Ueno, Y Murota, M Takeda, A Katayama, K Tanaka
Department of Cardiothoracic Surgery, JR Tokyo General Hospital, Tokyo, Japan.
A 30-year-old male who had suffered from the left hemopneumothorax due to the traffic
accident 13 years before was admitted to our hospital suffering from abdominal pain.
Computed tomography revealed the stomach was incarcerated through the left central
tendon of the left diaphragm. He was diagnosed as delayed traumatic diaphragmatic
hernia and emergency operation was performed via thoracic approach. Stomach and
omentum, densely adhered to the lung and the chest wall, were strangulated in the left
pleural cavity and hardly reducible. Stomach and omentum were reduced through the
enlarged hernia and necrotized stomach was totally resected under the subsequent
laparotomy. Hernia was closed directly via thoracic approach. A prompt diagnosis is
necessary for a case highly suspicious of delayed traumatic diaphragmatic hernias
presenting with strangulation.
Mesh-terms: Accidents, Traffic; Adult; Emergencies; Gastrectomy; Hernia,
Diaphragmatic, Traumatic :: complications; Hernia, Diaphragmatic, Traumatic ::
diagnosis; Hernia, Diaphragmatic, Traumatic :: surgery; Humans; Male; Necrosis;
Stomach Diseases :: etiology; Stomach Diseases :: pathology; Stomach Diseases ::
surgery; Time Factors; Tomography, X-Ray Computed;

Most cited papers:

J Trauma. 1988 Aug ;28 (8):1135-44 3411640 (P,S,G,E,B) Cited:8

[Cited?]
Delayed diagnosis of injuries to the diaphragm after penetrating wounds.
D V Feliciano, P A Cruse, K L Mattox, C G Bitondo, J M Burch, G P Noon, A C Beall Jr
Cora and Webb Mading Department of Surgery, Baylor College of Medicine, Houston,
TX 77030.
During a 9-year period, 16 patients with a delay in diagnosis of an injury to the
diaphragm after a penetrating wound were treated. The left hemidiaphragm was involved
in 15 of 16 patients, and the delay in diagnosis from the time of arrival in the emergency
center immediately after injury ranged from 16 hours to 14 years. In the patients in the
Acute Group (delay of hours to days), three patients had diaphragmatic defects missed at
the time of laparotomy, three patients had chest X-rays not immediately suggestive of
diaphragmatic defects, two patients had false-negative lavages, and one patient treated
elsewhere did not have a chest X-ray in the emergency room. In the patients in the
Chronic Group (hernias presenting months to years after injury), four of seven patients
had misreading of a recent chest X-ray or failure to have a chest X-ray performed during
numerous return visits to the emergency center. Despite a variety of diagnostic
maneuvers, these defects and hernias continue to be diagnosed after a delay. Careful
review of early and late followup chest X-rays appears to be the easiest mechanism to
avoid significant delays in diagnosis.
Mesh-terms: Adult; Diagnostic Errors; Diaphragm :: injuries; Diaphragm :: radiography;
Diaphragm :: surgery; Female; Hernia, Diaphragmatic, Traumatic :: diagnosis; Hernia,
Diaphragmatic, Traumatic :: radiography; Hernia, Diaphragmatic, Traumatic :: surgery;
Human; Male; Time Factors; Wounds, Penetrating :: complications;
Ann R Coll Surg Engl. 2000 Mar ;82 (2):97-100 10743425 (P,S,G,E,B) Cited:7
[Cited?]
Traumatic diaphragmatic rupture: associated injuries and outcome.
J Simpson, D N Lobo, A B Shah, B J Rowlands
Section of Surgery, University Hospital, Queen's Medical Centre, Nottingham, UK.
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. Patients were identified from the prospectively maintained UK Trauma and
Research Network Database. Of the 480 cases of torso trauma admitted during the study
period, 16 (3.3%) had TDR. Blunt trauma accounted for 13 (81%) of the injuries. A
radiological pre-operative diagnosis was made in 10 (62.5%) patients. Seven of these
were made on initial chest radiography, two on ultrasound scan and one on computed
tomography. All patients underwent a midline laparotomy and TDR was subsequently
diagnosed at operation in 6 patients. The left hemidiaphragm was ruptured in 14 (87.5%)
patients and there was visceral herniation in 8 (50%). Twelve patients with blunt trauma
had associated abdominal and extra-abdominal injuries, but only one of the three patients
with penetrating trauma had other injuries. The median Injury Severity Score (range) was
21 (9-50). The median time (range) spent on the intensive care unit was 2 days (0-35
days). Pulmonary complications occurred in 7 (44%) patients. Two (12.5%) patients died
from associated head injuries. TDR results from blunt and penetrating torso trauma, is
uncommon, rarely occurs in isolation and is associated with a high morbidity and
mortality. A high index of suspicion makes early diagnosis more likely as initial physical
and radiological signs may be lacking.
Mesh-terms: Adolescent; Adult; Child; Diaphragm :: injuries; Female; Hernia,
Diaphragmatic, Traumatic :: radiography; Hernia, Diaphragmatic, Traumatic :: surgery;
Human; Male; Middle Aged; Multiple Trauma :: surgery; Postoperative Complications;
Prognosis; Retrospective Studies; Rupture :: radiography; Rupture :: surgery;
Tomography, X-Ray Computed;
Chest. 1999 Jan ;115 (1):288-91 9925103 (P,S,G,E,B) Cited:7
[Cited?]
Tension fecopneumothorax due to colonic perforation in a diaphragmatic hernia.
M H Seelig, P J Klingler, K Schönleben
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. A tension
fecopneumothorax, however, is a rarity. We report on a patient who, 2 years after being
treated for a stab wound to the chest, presented with an acute tension fecopneumothorax
caused by the incarceration of the large bowel in the thoracic cavity after an intrathoracic
perforation. The etiology and management of this condition are discussed.
Mesh-terms: Adult; Colonic Diseases :: radiography; Colonic Diseases :: surgery;
Contrast Media; Diatrizoate Meglumine :: diagnostic use; Enema; Feces; Hernia,
Diaphragmatic, Traumatic :: radiography; Hernia, Diaphragmatic, Traumatic :: surgery;
Human; Intestinal Perforation :: radiography; Intestinal Perforation :: surgery; Male;
Pneumothorax :: radiography; Pneumothorax :: surgery; Tomography, X-Ray Computed;
Br J Surg. 1996 Jan ;83 (1):88-91 8653376 (P,S,G,E,B) Cited:7
[Cited?]
Diaphragmatic herniation after penetrating trauma.
E Degiannis, R D Levy, C Sofianos, T Potokar, M G Florizoone, R Saadia
Department of Surgery, Baragwanath Hospital, University of the Witwatersrand Medical
School, Johannesburg, South Africa.
A study was made of 45 patients with diaphragmatic herniation after penetrating trauma.
In 29 the diagnosis was established during the first admission (early presentation) and in
16 during a subsequent admission (delayed presentation). The mortality rate in the early
presentation group was 3 per cent compared with 25 per cent in the delayed presentation
group. The presence of gangrenous or perforated abdominal viscus in the chest cavity
was the single most common and severe aggravating factor. The need for diagnosis of
diaphragmatic herniation during the initial admission is emphasized. As isolated
diaphragmatic injuries provide few helpful clinical features to aid diagnosis, appropriate
investigations and good follow-up are of paramount importance in preventing late
herniation of intra-abdominal viscera through a penetrating diaphragmatic injury.
Mesh-terms: Adult; Female; Hernia, Diaphragmatic, Traumatic :: etiology; Hernia,
Diaphragmatic, Traumatic :: mortality; Hernia, Diaphragmatic, Traumatic :: surgery;
Human; Male; Middle Aged; Postoperative Complications; Retrospective Studies;
Wounds, Gunshot :: complications; Wounds, Gunshot :: surgery; Wounds, Stab ::
complications; Wounds, Stab :: surgery;
J R Soc Med. 1988 Sep ;81 (9):549-50 3184116 (P,S,G,E,B) Cited:7
[Cited?]
Faeco-pneumothorax as the presenting feature of a traumatic diaphragmatic hernia.
R F Phipps, B T Jackson
St Thomas's Hospital, London.
Mesh-terms: Colonic Diseases :: etiology; Colonic Diseases :: surgery; Feces; Hernia,
Diaphragmatic, Traumatic :: complications; Hernia, Diaphragmatic, Traumatic :: surgery;
Human; Intestinal Perforation :: etiology; Intestinal Perforation :: surgery; Male; Middle
Aged; Pneumothorax :: etiology;
Am J Surg. 1974 Aug ;128 (2):175-81 4843862 (P,S,G,E,B) Cited:2
[Cited?]
Traumatic injuries of the diaphragm. Diaphragmatic hernia.
O F Grimes
Mesh-terms: Diagnosis, Differential; Diaphragmatic Eventration :: diagnosis; Dilatation;
Hernia, Diaphragmatic, Traumatic :: diagnosis; Hernia, Diaphragmatic, Traumatic ::
radiography; Hernia, Diaphragmatic, Traumatic :: surgery; Human; Kidney :: injuries;
Liver :: injuries; Methods; Pneumothorax :: diagnosis; Spleen :: injuries; Stomach
Diseases :: diagnosis; Thoracic Injuries :: complications; Thoracic Injuries :: surgery;
Time Factors;
Surg Clin North Am. 2000 Feb ;80 (1):213-39, xi 10685150 (P,S,G,E,B) Cited:1
[Cited?]
Surgical embryology and anatomy of the diaphragm with surgical applications.
V Schumpelick, G Steinau, I Schlüper, A Prescher
Department of Surgery, University Hospital, University of Technology at Aachen,
Germany.
This article reviews the development, surgical anatomy, and teratology of the diaphragm,
and discusses the diagnostic procedures, surgical therapy, and prognosis of congenital
disturbances. Special attention is paid to the traumatic rupture of the diaphragm,
concerning incidence, cause, diagnosis, prognosis, and surgical repair.
Mesh-terms: Diagnostic Imaging; Diaphragm :: abnormalities; Diaphragm :: embryology;
Diaphragm :: pathology; Diaphragm :: surgery; Diaphragmatic Eventration ::
embryology; Diaphragmatic Eventration :: pathology; Diaphragmatic Eventration ::
surgery; Hernia, Diaphragmatic :: embryology; Hernia, Diaphragmatic :: pathology;
Hernia, Diaphragmatic :: surgery; Hernia, Diaphragmatic, Traumatic :: embryology;
Hernia, Diaphragmatic, Traumatic :: pathology; Hernia, Diaphragmatic, Traumatic ::
surgery; Human; Laparoscopy;
Aust Vet J. 1996 Jul ;74 (1):25-30 8894000 (P,S,G,E,B) Cited:1
[Cited?]
Outcomes of thoracic surgery in dogs and cats.
C R Bellenger, G B Hunt, S E Goldsmid, M R Pearson
Department of Veterinary Clinical Sciences, University of Sydney, New South Wales.
Records of 146 dogs and 41 cats that underwent thoracic surgery at The University of
Sydney Veterinary Teaching Hospital were reviewed for age, sex, breed, disease,
operation date, periods of pre- and post-operative hospitalisation, use of surgical drains
and outcome. Animals were assigned to 16 disease categories, the most common being
patent ductus arteriosus, traumatic diaphragmatic hernia and oesophageal foreign body in
dogs and traumatic diaphragmatic hernia in cats. Differences were observed between
disease categories in all the criteria examined. There were almost equal numbers of male
(72) and female (74) dogs, the median (range) age was 2.0 (0.2 to 14.0) years, the median
pre-operative stay was 1 (0 to 14) days, the median post-operative stay was 4 (0 to 28)
days and the overall survival to discharge rate was 78%. There were 24 male and 15
female cats (sex not recorded in 2 cats). The median (range) age was 3 (0.1 to 12) years,
pre-operative stay 1 (0 to 6) days, post-operative stay 5 (0 to 15) days and the overall
survival to discharge rate was 85%. Causes of post-operative deaths among animals in the
most common categories are recorded and discussed.
Mesh-terms: Age Factors; Animals; Cat Diseases :: mortality; Cat Diseases :: surgery;
Cats; Dog Diseases :: mortality; Dog Diseases :: surgery; Dogs; Drainage :: veterinary;
Ductus Arteriosus, Patent :: surgery; Ductus Arteriosus, Patent :: veterinary; Esophagus;
Female; Foreign Bodies :: surgery; Foreign Bodies :: veterinary; Hernia, Diaphragmatic,
Traumatic :: surgery; Hernia, Diaphragmatic, Traumatic :: veterinary; Length of Stay;
Ligation :: veterinary; Male; Pleural Effusion :: surgery; Pleural Effusion :: veterinary;
Retrospective Studies; Sex Factors; Survival Analysis; Thoracic Surgery :: statistics &
numerical data; Treatment Outcome;
Arch Surg. 1982 Jan ;117 (1):18-24 7055422 (P,S,G,E,B) Cited:1
[Cited?]
Traumatic diaphragmatic hernia.
 J H Payne, A E Yellin
The records of 36 patients with traumatic diaphragmatic hernia (TDH) were reviewed. In
14, acute hernias were diagnosed, but the diagnosis was made one month to 15 years after
injury in 22 patients with chronic hernia. Seven acute TDHs were due to blunt and seven
to penetrating trauma. Four chronic TDHs were due to blunt and 18 to penetrating
trauma. Chest pain, abdominal pain, or dyspnea occurred in each acute case and in 18 of
22 chronic cases. Plain chest roentgenograms were abnormal in 33 of 36 cases. Pleural
effusion or abnormal diaphragmatic contour were common abnormal findings.
Supradiaphragmatic bowel, pathognomonic of TDH, was evident in seven acute and eight
chronic hernias. Celiotomy was routinely employed in acute hernias, celiotomy or
thoracotomy in chronic hernias. There were three deaths, two with associated CNS injury
and one with chronic pulmonary disease.
Mesh-terms: Abdominal Injuries :: diagnosis; Abdominal Injuries :: etiology; Abdominal
Injuries :: surgery; Acute Disease; Adolescent; Adult; Aged; Chronic Disease;
Comparative Study; Female; Hernia, Diaphragmatic, Traumatic :: diagnosis; Hernia,
Diaphragmatic, Traumatic :: etiology; Hernia, Diaphragmatic, Traumatic :: surgery;
Human; Male; Middle Aged; Pleural Effusion :: diagnosis; Pleural Effusion :: etiology;
Pleural Effusion :: surgery; Radiography, Thoracic; Wounds, Nonpenetrating ::
complications; Wounds, Penetrating :: complications;
Am J Surg. 1984 Aug ;148 (2):292-5 6465438 (P,S,G,E,B) Cited:1
[Cited?]
Blunt diaphragmatic rupture.
G Beauchamp, A Khalfallah, R Girard, S Dube, F Laurendeau, G Legros
Diaphragmatic injury is often a missed diagnosis in patients with multiple trauma. For
this reason, mortality can be high. From 1970 to 1981, 32 patients with diaphragmatic
injuries were seen at Maisonneuve-Rosemont Hospital. Twenty-four of the patients (22
men and 2 women aged 18 to 79 years) had blunt abdominal or thoracic trauma causing
diaphragmatic disruption. Rupture occurred 20 times on the left side of the diaphragm,
and 3 times on the right side. There was one pericardiophrenic rupture. Motor vehicle
accident was the most common cause of trauma. On arrival, 21 patients had acute
diaphragmatic rupture. Clinical signs and radiography permitted early diagnosis in 15
patients, whereas diagnosis was made later in 3 other patients because of deterioration of
vital signs. In two patients, diagnosis was made at laparotomy for another reason. Four
patients were operated on for post-traumatic chronic diaphragmatic hernia. The
abdominal approach was used in 18 patients, the thoracic approach in 4, and the
thoracoabdominal approach in 2. Three patients died, two of whom had a late diagnosis.
Fourteen patients had no complications. Diaphragmatic trauma can be easily managed
surgically when diagnosis is made early after trauma. It must always be looked for in
patients with multiple trauma.