To date, only about 100 such cases of leftsided and 10 such cases of rightsided diaphragmatic hernia have been reported 9,10. Article traumatic diaphragmatic hernia applied radiology. And they may stay unrecognized after injury, only presenting months or years later with strangulation of an. The definition of diaphragmatic hernia requires the protrusion of abdominal viscera through a congenital or acquired opening in the diaphragm into the thorax. Traumatic diaphragmatic hernias tdh are rare but life threatening entities. The diagnosis of post traumatic diaphragmatic hernia according to the time of injury and onset of symptoms is classified as follows 9 type 1 hernia immediate diagnosis following trauma type 2 hernia when the diagnosis is within the recovery period type 3 hernia patient presents with ischemia or perforation of herniated organs. Cdh has an incidence of 1 in 2500 live births in the uk. Small bowel obstruction severe pain and inflammation tenderness, induration, redness over the hernia site later. Seven acute tdhs were due to blunt and seven to penetrating trauma. Traumatic diaphragmatic hernia was rightsided in 5 27. The most common con tents of a traumatic diaphragmatic hernia are stomach, large and small bowel. Associated abdominal injuries identified at the initial exploration are also addressed at this time.
The diaphragm is the muscular separation between the chest and abdominal cavities that functions as a barrier and aids in respiration. Dh occurs when the continuity of the diaphragm is disrupted such that the abdominal organs can migrate into the thoracic cavity. Ctscan of the abdomen and thorax showed a left diaphragmatic hernia. Traumatic diaphragmatic hernia occurs in less than 50% of the patients with diaphragmatic injuries. Diaphragmatic hernia thorsang chayovan chaiyapongse tangsittitum pgy2 radiology 2. Traumatic diaphragmatic hernia challenging diagnosis and.
Delayed traumatic rupture of the diaphragm in pregnancy. Pdf a rare case of chronic traumatic diaphragmatic hernia. With an increase in natural disasters and accidents, blunt traumatic diaphragmatic hernia incidence will continue to increase and those managing trauma injuries must be alert to the possibility of pericardial injury. A significant complication of diaphragmatic rupture is traumatic diaphragmatic herniation. Traumatic diaphragmatic hernia article pdf available in indian journal of surgery 702. Average age of the patients was 30 years and the female to male ratio was 4. Diaphragmatic hernias require a high level of suspicion to detect. Abdominal trauma is frequently encountered, but traumatic injuries to the diaphragm are often missed. Traumatic diaphragmatic hernia jama surgery jama network. Patients can be asymptomatic in up to 53% of hernias from blunt trauma and 44. Diaphragmatic hernia, traumatic quick answers surgery. It is the aim of this case study to highlight the difficulties encountered with the earlier detection of traumatic diaphragmatic hernias.
Diaphragmatic rupture is an uncommon condition, and in 80% of cac ses o. A diaphragmatic hernia occurs when one or more of your abdominal organs move upward into your chest through a defect opening in the diaphragm. Traumatic diaphragmatic hernias tdhs are sometimes difficult to identify at an early stage and can consequently result in diagnostic delays with lifethreatening outcomes. Each case represents a different presentation of this condition, which may follow blunt or penetrating trauma or iatrogenic injury. Early diagnosis of traumatic diaphragmatic hernia is necessary to decrease morbidity and mortality associated with it. Laparoscopic repair of delayed traumatic diaphragmatic hernia with mesh cihan agalar1, sami benli1, tufan egeli1, mucahit ozbilgin1 and isil basara2 1 department of general surger y, school of medicine, dokuz eylul university, izmir, turkey 2department of radiology, school of medicine, dokuz eylul university, izmir, turkey corresponding author. Diaphragmatic hernia can also be caused by a defect in the diaphragm and is divided into congenital and acquired forms, where the latter may be confounded with morgagni hernia. Laparoscopic repair of delayed traumatic diaphragmatic hernia. Congenital diaphragmatic hernia cdh is a birth defect of the diaphragm. Diaphragmatic hernia may present in the acute phase after injury but late presentation may occur after many years, with chronic abdominal or respiratory symptoms, or with acute intestinal obstruction. Normal ventilatory function is achieved only by restoring diaphragmatic integrity. Evaluation and management of traumatic diaphragmatic injuries.
Intro a hernia is an abnormal protrusion of an organ or a portion of it through the containing wall of its cavity, beyond its normal confines. Pdf laparoscopic repair of traumatic diaphragmatic. In 14, acute hernias were diagnosed, but the diagnosis was made one month to 15 years after injury in 22 patients with chronic hernia. Laparoscopic repair of delayed traumatic diaphragmatic. The cause of rupture was blunt trauma in 2483% patients and penetrating trauma in 517% patients. The majority of adults who experience discomfort related to their condition have experienced some kind of trauma prior to symptom manifestation. Complications of congenital posterolateral diaphragmatic hernia in the adult. A true hernia requires the presence of a sac composed of a layer of peritoneum within and a layer of pleura without. Hernias may be internal, external, congenital, or acquired. Pdf surgical repair of a diaphragmatic hernia in a racehorse. Diagnosis of a bohcdalek diaphragmatic hernia in the acute setting can be very challenging. Twenty nine patients underwent surgery for traumatic diaphragmatic hernia. Traumatic diaphragmatic hernia tdh or rupture is a serious complication of abdominal or thoracic trauma. Diaphragmatic rupture and its complications following.
Patients with traumatic diaphragmatic hernias often had a history of penetrating or blunt trauma. Pdf introduction traumatic diaphragmatic hernia is a rare and often under recognized complication of penetrating and blunt trauma. Multiple imaging modalities are available to evaluate the diaphragm following trauma. The frequency of motor vehicle accidents and injuries resulting from physical violence calls for an increased awareness of the possibility of traumatic diaphragmatic hernia in the acutely injured patient. Frequently, diaphragmatic hernias occur in conjunction with a traumatic event, such as being hit by a car. Evaluation and management of traumatic diaphragmatic. Traumatic intrapericardial diaphragmatic hernia diagnosed by echocardiography. This is a photo of a peritoneopericardial diaphragmatic hernia in a cat. The traumatic diaphragmatic hernia diagnosis is based. To the left is the abdomen, where part of the liver and the gall bladder can be seen. As in infants, most diaphragmatic hernias in adults 85% occur on the left 4. The photo was taken during necropsy from the right side of the cat. Coronal noncontrast the stomach, portions of the small and large bowels, and large amount of mesentery are seen herniated through the left hemithorax. One of the largest contemporary case series of post traumatic diaphragmatic hernia tdh was published by murray et al.
Surgical repair of a diaphragmatic hernia in a racehorse article pdf available in journal of the american veterinary medical association 21410. Rightsided defects are less common because closure of the right. Posttraumatic right diaphragmatic hernia with hepatothorax. Sudden death due to nontraumatic diaphragmatic hernia in. Traumatic diaphragmatic hernias tdhs are uncommon, but lifethreatening, and remain a diagnostic and therapeutic challenge with an overall mortality rate of up to 31% in recent series. On the histological level, its difficult to determine which feature preceded, the timing of the tumor relative to the hernia is a real challenge. Traumatic diaphragmatic hernia presents unique obstacles to a minimal invasive approach. Havard from sully hospital, glamorgan received for publication february, 1961 rupture of the diaphragm and herniation of the abdominal viscera into the chest are wellrecognized results of crushing or penetrating injuries. Traumatic diaphragmatic hernia can present immediately following injury, but may be overlooked in the urgency to evaluate and treat patients with multiple trauma. Incidence of diaphragmatic hernia secondary to blunt trauma 0. A diaphragmatic hernia and pericardial rupture caused by. More recent publications have shown an increased incidence of right sided traumatic diaphragmatic rupture. Diaphragmatic injuries are quite uncommon and often result from either blunt or penetrating trauma.
Diaphragmatic hernia protrusion of abdominal cavity beyond walls through muscular opening in diaphragm enlargement of esophageal hiatus due to developmental defects increased abdominal thoracic pressure gradient altered collagen metabolism depletion of elastic fibers in phrenoesophageal membrane waging. More than 90% of blunt traumatic diaphragmatic ruptures result from motor vehicle accidents, as was the case in this patient. The necessity of immediate laparotomy in patients with acute diaphragmatic hernia appears indicated by the high incidence of as. The mechanism of diaphragmatic tear with blunt trauma is described and modes of diagnosis and treatment are discussed. Sudden death in an adult due to an undiagnosed congenital diaphragmatic hernia cdh is a very rare occurrence.
In 21 72% patients the diagnosis was made within 24hrs and in 828% patients the diagnosis was made after 24hrs. Traumatic diaphragmatic hernia has always been a diagnostic challenge to both the radiologist and surgeon. Traumatic diaphragmatic hernia the annals of thoracic surgery. Diaphragmatic hernia american college of veterinary. Spontaneous acquired diaphragmatic hernia without any apparent history of trauma is a very rare condition and is very difficult to diagnose figure 2. A colon tumor revealed by a post traumatic diaphragmatic hernia has never been described to our knowledge. Diaphragmatic hernia is the disruption of the diaphragm which allows abdominal organs to migrate into the chest cavity. Two general types of injuryblunt external trauma and penetrating woundsare responsible for most injuries to the diaphragm, producing more than 98% of those. Early diagnosis and management of traumatic diaphragmatic hernia tdhcan be challenging for the emergency. A 6yearold boy presented to the hospital after several hours of vomiting and dyspnea. Traumatic diaphragmatic herniaour experience sciencedirect. Gordon bryans study 1921 of both types of injury is a surgical.
Diaphragm injuries are diagnosed in the acute phase of blunt trauma only in 10% of casesmore often they are presented as hernia. Pdf traumatic diaphragmatic hernia challenging diagnosis and. Diaphragmatic rupture leads to a traumatic diaphragmatic hernia. Delayed recognition of tdi resulting in diaphragmatic hernia is problematic due to the associated morbidity and mortality. Despite the widespread use of computed tomography in trauma. Bochdalek and morgagni hernias, along with diaphragmatic eventration, typically originate in utero from developmental weaknesses or defects in the diaphragm. Outline anatomy embryology anatomic variants diaphragmatic hernias congenital. Post traumatic diaphragmatic hernia revealing a colonic. The incidence of tdh in trauma patients is around 0.
Published reports indicate that patients with traumatic diaphragmatic herniation have a guarded prognosis. Diaphragmatic hernia and injury linkedin slideshare. The presence of colonic tumor can precede the development of diaphragmatic hernia. Overshadowing injury to the bony skeleton, central nervous system, lungs, or abdominal viscera may obscure a. The entity of diaphragmatic rupture post trauma was first described by sennertus in 1541. These compress and displace the left lung parenchyma. The current status of traumatic diaphragmatic injury. A traumatic diaphragmatic hernia is caused as a result from blunt or penetrating trauma and occurs in about 5% of cases of severe blunt trauma to the trunk. Chilaiditis sign mimicking a traumatic diaphragmatic hernia.