Delayed diagnosis of diaphragmatic rupture after blunt chest trauma – 2 case reports
Authors:
M. Skála; J. Vodička; V. Špidlen; K. Procházková; J. Šebek; V. Třeška
Authors place of work:
Chirurgická klinika Lékařské fakulty Univerzity Karlovy a Fakultní nemocnice v Plzni
Published in the journal:
Rozhl. Chir., 2022, roč. 101, č. 6, s. 284-288.
Category:
Case Report
doi:
https://doi.org/10.33699/PIS.2022.101.6.283–287
Summary
Introduction: Diaphragmatic rupture is a rare but life-threatening condition that occurs in 0.85% of surgically managed thoracoabdominal injuries. In most cases, the condition is accompanied by associated traumas responsible for poor prognosis. Signs of diaphragmatic rupture are often masked by more serious manifestations of the associated trauma. The rupture is usually revealed by an X-ray of the chest or CT scan. However, a minor defect may be missed, especially if the patient is not indicated for urgent surgery.
Methods: The authors present 2 case reports of patients treated for chronic diaphragmatic rupture at the Department of Surgery of the Faculty of Medicine, Charles University and University Hospital in Pilsen between 01 January 2009 and 31 December 2021. The aim was to analyze the clinical data and to compare this data with literature.
Results: Both patients with the chronic diaphragmatic rupture were men in their productive age. The mechanism of their primary trauma was a traffic accident. In the first case, the rupture was diagnosed 6 years after the trauma. The second case was diagnosed 14 years after the primary trauma. The diaphragmatic rupture was present on the left side in the first case and on the right in the other. Both patients underwent suture of the diaphragmatic defect via thoracotomy.
Conclusion: Unrecognized diaphragmatic rupture is a severe condition that can result in a life-threatening complication, namely incarceration of abdominal organs dislocated to the chest. It is necessary to keep this diagnosis in mind in patients with gastrointestinal or respiratory problems after a previous high-energy, blunt-force abdominal and thoracic injury, even many years after the trauma.
Keywords:
diaphragmatic rupture – thoracoabdominal trauma
Zdroje
1. Tavakoli H, Rezaei J, Miratashi Yazdi SA, et al. Traumatic right hemi-diaphragmatic injury: delayed diagnosis. Surgical Case Reports 2019;5(1):92. ISSN 2198-7793. doi:10.1186/s40792-019-0650-5.
2. Gu P, Lu Y, Li X, et al. Acute and chronic traumatic diaphragmatic hernia: 10 years’ experience. PLOS ONE 2019;14(12), e0226364. ISSN 1932-6203. doi:10.1371/ journal.pone.0226364.
3. Vyhnánek F, Jirava P, Skála P, et al. The spectrum of diaphragmatic injuries managed in a Prague traumatology centre. [In Czech] Rozhledy v chirurgii 2011;90(7):377–381. ISSN 0035-9351.
4. Vodička J, Doležal J, Vejvodová Š, et al. Chest injury and its surgical treatment in polytrauma patients. Five-year experience. [In Czech] Acta Chirurgiae Orthopaedicae Et Traumatologiae Cechoslovaca. 2016;83(2):123–126. ISSN 0001-5415.
5. Fangbiao Z, Chunhui Z, Chun Z, et al. Thoracotomy for traumatic diaphragmatic hernia. Indian Journal of Surgery 2016;78(5):371–374. ISSN 0972-2068, 0973-9793. doi:10.1007/s12262-016- 1484-z.
6. Vodička J, et al. Traumatologie hrudníku. Praha, Galén 2015. ISBN 978-80-7492- 168-1.
7. Lim KH, Park J. Blunt traumatic diaphragmatic rupture: Single-center experience with 38 patients. Medicine 2018;97(41), e12849. ISSN 0025-7974, 1536-5964. doi:10.1097/MD.0000000000012849.
8. Schützner J, Šimonek J, Stolz A, et al. Ruptures of the diaphragm. [In Czech] Rozhledy v chirurgii 2017;96(12):493– 497. ISSN 0035-9351.
9. Blitz M, Louie BE. Chronic traumatic diaphragmatic hernia. Thoracic Surgery Clinics 2009;19(4):491–500. ISSN 1547-4127. doi:10.1016/j.thorsurg.2009.08.001.
10. Zhao L, Han Z, Liu H, et al. Delayed traumatic diaphragmatic rupture: diagnosis and surgical treatment. Journal of Thoracic Disease 2019;11(7):2774–2777. ISSN 20721439, 20776624. doi:10.21037/ jtd.2019.07.14.
11. Lu J, Wang B, Che X, et al. Delayed traumatic diaphragmatic hernia: A case-series report and literature review. Medicine 2016;95(32):e4362. ISSN 0025-7974. doi:10.1097/MD.0000000000004362.
12. Corbellini C. Diaphragmatic rupture: a single-institution experience and review of the literature. Turkish Journal of Trauma and Emergency Surgery 2017;[vid. 2021-07-05]. ISSN 1306696X. doi:10.5505/tjtes.2017.78027.
13. Puffer P, Gaebler M. Traumatic diaphragmatic rupture in a forensic medicine autopsy sample. [In German] Beitrage Zur Gerichtlichen Medizin 1991;49:149–152. ISSN 0067-5016.
14. Hanna WC, Ferri LE, Fata P, et al. The current status of traumatic diaphragmatic injury: lessons learned from 105 patients over 13 years. The Annals of Thoracic Surgery 2008;85(3):1044–1048. ISSN 1552-6259. doi:10.1016/j.athoracsur. 2007.10.084.
15. Antoiou SA, Pointner R, Granderath FA, et al. The use of biological meshes in diaphragmatic defects – an evidence-based review of the literature. Frontiers in Surgery 2015;2:56. ISSN 2296-875X. doi:10.3389/fsurg.2015.00056.
Štítky
Surgery Orthopaedics Trauma surgeryČlánok vyšiel v časopise
Perspectives in Surgery
2022 Číslo 6
- Spasmolytic Effect of Metamizole
- Metamizole at a Glance and in Practice – Effective Non-Opioid Analgesic for All Ages
- Metamizole in perioperative treatment in children under 14 years – results of a questionnaire survey from practice
Najčítanejšie v tomto čísle
- Retroperitoneal fibrosis – diagnosis and treatment
- Atraumatic acute compartment syndrome – case report
- Defensive medicine and the influence of litigation on doctors
- Delayed diagnosis of diaphragmatic rupture after blunt chest trauma – 2 case reports