Early and Delayed Presentation of Left-sided Diaphragmatic Rupture Secondary to Blunt Trauma: Report of Three Cases
Nuray Colapkulu-Akgul, Ozgur Ekinci, Orhan Alimoglu
Blunt trauma, Diaphragmatic injury, Minimal invasive surgery
Citation Information :
Colapkulu-Akgul N, Ekinci O, Alimoglu O. Early and Delayed Presentation of Left-sided Diaphragmatic Rupture Secondary to Blunt Trauma: Report of Three Cases. Panam J Trauma Crit Care Emerg Surg 2022; 11 (2):90-94.
Aim: The aim is to present three cases of left-sided diaphragmatic hernias due to blunt trauma that were treated by surgical repair.
Background: Diaphragmatic rupture with herniation of abdominal organs is an uncommon injury after blunt trauma. Patients may present with acute respiratory distress or without any symptoms. After an appropriate diagnostic workup, surgical repair is the treatment of choice.
Case description: Three patients presented with a left-sided diaphragmatic hernia after falling from heights in the early and late periods following the trauma. Two patients with early presentations had respiratory symptoms and one patient with late presentation was admitted with acute mechanical intestinal obstruction. All patients were treated with surgery via an abdominal approach.
Conclusion: Left-sided diaphragmatic injuries carry a high risk for herniation of intra-abdominal organs and should be immediately surgically repaired.
Clinical significance: Diaphragmatic hernia is rare after blunt trauma and should not be missed in the initial evaluation. The techniques of surgical repair may vary according to the experience of the surgeons and the general condition of the patients.
Fair KA, Gordon NT, Barbosa RR, et al. Traumatic diaphragmatic injury in the American College of Surgeons National Trauma Data Bank: a new examination of a rare diagnosis. Am J Surg 2015;209(5):864–869. DOI: 10.1016/j.amjsurg.2014.12.023
Okan I, Bas G, Ziyade S, et al. Delayed presentation of posttraumatic diaphragmatic hernia. Ulus Travma Acil Cerrahi Derg 2011;17(5):435–439. DOI: 10.5505/tjtes.2011.89804
Perrone G, Giuffrida M, Annicchiarico A, et al. Complicated diaphragmatic hernia in emergency surgery: systematic review of the literature. World J Surg 2020;44(12):4012–4031. DOI: 10.1007/s00268-020-05733-6
Somford MP, Nuytinck HKS, Vos DI. A case of delayed diagnosis of a right-sided diaphragm rupture with a review of the literature. Eur J Trauma Emerg Surg 2009;35(5):499–502. DOI: 10.1007/s00068-008-8124-7
Silva GP, Cataneo DC, Cataneo AJM. Thoracotomy compared to laparotomy in the traumatic diaphragmatic hernia. Systematic review and proportional methanalysis. Acta Cir Bras 2018;33(1):49–66. DOI: 10.1590/s0102-865020180010000006
McDonald AA, Robinson BRH, Alarcon L, et al. Evaluation and management of traumatic diaphragmatic injuries: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 2018;85(1):198–207. DOI: 10.1097/ta.0000000000001924
Alimoglu O, Eryilmaz R, Sahin M, et al. Delayed traumatic diaphragmatic hernias presenting with strangulation. Hernia 2004;8(4):393–396. DOI: 10.1007/s10029-004-0225-6
Gao J, Du D, Li H, et al. Traumatic diaphragmatic rupture with combined thoracoabdominal injuries: difference between penetrating and blunt injuries. Chin J Trauma 2015;18(1):21–26. DOI: 10.1016/j.cjtee.2014.07.001
Williams M, Carlin AM, Tyburski JG, et al. Predictors of mortality in patients with traumatic diaphragmatic rupture and associated thoracic and/or abdominal injuries. Am Surg 2004;70(2):157–162.
Mansour KA. Trauma to the diaphragm. Chest Surg Clin N Am 1997;7(2):373–383.
Yucel M, Bas G, Kulalı F, et al. Evaluation of diaphragm in penetrating left thoracoabdominal stab injuries: the role of multislice computed tomography. Injury 2015;46(9):1734–1737. DOI: 10.1016/j.injury.2015.06.022
Vilallonga R, Pastor V, Alvarez L, et al. Right-sided diaphragmatic rupture after blunt trauma. An unusual entity. World J Emerg Surg 2011;6(1):3. DOI: 10.1186/1749-7922-6-3
Heiwegen K, de Blaauw I, Botden SMBI. A systematic review and meta-analysis of surgical morbidity of primary versus patch repaired congenital diaphragmatic hernia patients. Sci Rep 2021;11(1):12661. DOI: 10.1038/s41598-021-91908-7
Ramakrishna HK, Lakshman K. Intra peritoneal polypropylene mesh and newer meshes in ventral hernia repair: what EBM says? Indian J Surg 2013;75(5):346–351. DOI: 10.1007/s12262-012-0743-x