Traumatic diaphragmatic rupture: associated injuries and outcome.
(1/38)
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. (+info)
Traumatic diaphragmatic hernia in a clinically normal dog.
(2/38)
A 3.5-year-old border collie was presented for routine ovariohysterectomy. A preoperative physical examination revealed no abnormalities, but, under anesthesia, the patient became dyspneic and cyanotic. Plain radiography indicated the presence of a diaphragmatic hernia. The herniated structures were returned to the abdomen and the diaphragmatic defect was surgically repaired. (+info)
Iatrogenic gastric fistula due to inappropriate placement of intercostal drainage tube in a case of traumatic diaphragmatic hernia.
(3/38)
A 26-year-old, 30 weeks primigravida presented with a gastric fistula through a left intercostal drain, which was inserted for drainage of suspected haemopneumothorax following minor trauma. It was confirmed to be a diaphragmatic hernia, with stomach and omentum as its contents. On exploratory laparotomy, disconnection of the tube and fistulous tract, with reduction of herniated contents and primary suturing of stomach was carried out. Diaphragmatic reconstruction with polypropylene mesh was also carried out. Post-operative recovery was uneventful with full lung expansion by 3rd postoperative day. Patient was asymptomatic at follow-up 6 months. (+info)
Traumatic diaphragmatic rupture: personal experience.
(4/38)
402 thoracoabdominal traumas have been observed since November 1998 and seven of these patients (1.7%) showed a diaphragmatic rupture. Four patients showed a right diaphragm rupture and three a left diaphragm rupture. Road traffic accidents were the main cause of trauma. Early diagnosis was performed in three patients (43%), a delayed diagnosis was made to the other patients (57%): one case was an intraoperative diagnosis (14.2%). Everyone had chest X rays and chest and upper abdomen CT scan. One patient had MRI on a late diagnosis. Thoracotomy was performed in all patients and one case (14.2%) of morbility and one (14.2%) of mortality were observed. (+info)
Traumatic diaphragmatic herniation presenting as a delayed tension faecopneumothorax.
(5/38)
This article reports an unusual case of delayed presentation of a tension faecopneumothorax after traumatic injury to the diaphragm 5 years previously. Three important clinical lessons are highlighted: (a) for suspected tension pneumothorax, if a considerable quantity of serous fluid is drained in addition to air, a communication with the peritoneal cavity should be considered; (b) spontaneous tension pneumothorax is an extremely rare condition and other causes should be kept in mind; and (c) in the presence of a tension pneumothorax and diaphragmatic hernia, the contents of the visceral sac may be completely reduced and the hernia may be masked. (+info)
Delayed presentation of gastrothorax masquerading as pneumothorax.
(6/38)
We report a case of traumatic diaphragmatic rupture (TDR) following an unusual blunt trauma. The history and initial chest radiograph prompted an insertion of a nasogastric tube which confirmed our diagnosis and decompressed the intra-thoracic gastric contents. We discuss briefly the diagnostic approach to the clinical management of TDR. (+info)
Thoracoscopy in the diagnosis and treatment of thoracoabdominal stab injuries.
(7/38)
BACKGROUND: Occult diaphragmatic injuries are associated with significant mortality, if the diagnosis is delayed. We report our experience in diagnostic and therapeutic thoracoscopy in a selected group of patients with stab wounds of thoracoabdominal region. METHODS: The patients who underwent thoracoscopic management of thoracoabdominal stab injuries between June 2001-December 2005 were included into the study. The data were retrospectively analyzed. RESULTS: Ninety-three patients with abdominal and thoracoabdominal stab wounds underwent videoendoscopic management. Among them, eleven selected patients with thoracoabdominal stab injuries were managed by thoracoscopy. The procedures were performed under general (n=10) or local anesthesia (n=1). Diaphragmatic injuries were repaired by intracorporeal sutures in three cases and bleeding was controlled in another two cases by electrocautery coagulation. The procedures were simply diagnostic in six patients. The mean operating time and hospital stay were 35 minutes and 3.5 days respectively. There was neither intraoperative or early postoperative complication, nor mortality. CONCLUSION: Thoracoscopy is a safe and efficient tool in the diagnosis and treatment of diaphragmatic stab injuries. (+info)
Late complication of diaphragmatic gunshot injury: appendix perforation due to colon incarceration.
(8/38)
Missing the diaphragmatic injury on first admission is often associated with late complications. A 38 year-old male patient is presented here as a case of missed diaphragmatic injury due to gunshot injury resulted with fecal peritonitis. Celiotomy revealed a distended appendix perforation due to herniated left colon obstruction through the left pleural cavity. Left colon and stomach were reduced to peritoneal cavity and diaphragm was repaired with interrupted polypropylene sutures. After being sure about the viability of the colon and stomach, appendectomy with cecal exteriorization was performed. Postoperative period was uneventful. The patient was discharged on the 10th postoperative day. A thorough inspection of the diaphragm is essential in thoraco-abdominal trauma. Repair of the diaphragmatic defects should invariably carried out to avoid life-threatening complications. (+info)