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Hernia

, Volume 5, Issue 1, pp 25–29 | Cite as

Traumatic diaphragmatic hernias: a report of 26 cases

  • T. Z. NursalEmail author
  • M. Ugurlu
  • M. Kologlu
  • E. Hamaloglu
Papers

Abstract

Traumatic diaphragmatic hernias, when diagnosed many years after the traumatic event, are observed in about 10% of diaphragmatic injuries. Due to coexisting injuries and the silent nature of diaphragmatic injuries, the diagnosis is easily missed or difficult. The medical records of 26 patients, who were treated for diaphragmatic hernias during the last 20 years, were analysed retrospectively. The patients were divided into acute phase and late-presenting groups, in whom emergency surgery and elective intervention were performed respectively. Chest radiography was diagnostic in 34.6% (n=9) of patients. 92.3% of the hernias were on the left side, while the most common herniated organs were the stomach (31.8%) and the colon (27.2%). Coexisting injuries were recorded in 38.4% (n=10) of the patients. Primary repair was predominantly used (92.3%). The hospitalisation period was longer in the late-presenting group (24.1±18.8 vs. 14.3±7.7 days). Two deaths occurred in the late-presenting group. Diaphragmatic hernia should be suspected in all blunt abdominal trauma patients. Prompt surgical repair is the treatment of choice in all traumatic diaphragmatic hernias.

Key words

Diaphragmatic hernia Trauma Blunt abdominal trauma 

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References

  1. Arendrup HC, Arendrup KD (1989) Traumatic diaphragmatic hernia. In: Nyhus LM, Condon RE (eds) Hernia 3rd ed. JB Lippincott Company, Philadelphia, pp 708–716Google Scholar
  2. Athanassiadi K, Kalavrouziotis G, Athanassiou M, Vernikos P, Skrekas G, Poultsidi A, Bellenis (1999) Blunt diaphragmatic rupture. Eur J Cardiothorac Surg 15:469–74Google Scholar
  3. Ball T, McCrory R, Smith JO, Clements JL (1982) Traumatic diaphragmatic hernia: Errors in diagnosis. AJR 138:633–637Google Scholar
  4. Brown GL, Richardson JD (1985) Traumatic diaphragmatic hernia: a continuing challenge. Ann Thorac Surg 39:170–173Google Scholar
  5. Cruz CJ, Minagi H (1994) Large-bowel obstruction resulting from traumatic diaphragmatic hernia:imaging findings in four cases. AJR 162:843–845Google Scholar
  6. Freixinet JL, Segur JM, Mestres CA, Mateu M, Gimferrer JM, Catalan M, Callejas MA, Letang E, Sanchez-Lloret J (1987) Traumatic injuries of the diaphragm. Experience in 33 cases. Thorac Cardiovasc Surg 35:215–218Google Scholar
  7. Kurata K, Kubota K, Oosawa H, Eda N, Ishihara T (1996) Thoracoscopic repair of traumatic diaphragmatic rupture. A case report. Surg Endosc 10:850–1Google Scholar
  8. Lee WC, Chen RJ, Fang JF, Wang CC et al (1994) Rupture of the diaphragm after blunt trauma. Eur J Surg 160:479–483Google Scholar
  9. Lorimer JW, Reid KR, Raymond F (1994) Blunt extraperitoneal rupture of the right hemidiaphragm: case report. J Trauma 36:414–416Google Scholar
  10. Meyers BF, McCabe CJ (1993) Traumatic diaphragmatic hernia: Occult marker of serious injury. Ann Surg 218 (6):783–790Google Scholar
  11. Moore EE, Cogbill TH, Malangoni MA, Jurkovich GJ, Shackford SR, Champion HR, McAninch JW (1995) Organ injury scaling. Surg Clin N Amer 75:293–303Google Scholar
  12. Nano M, Dei Poli M, Mossetti C, Maggi G (1980) Traumatic diaphragmatic hernias. Surg Gynecol Obstet 151:191–192Google Scholar
  13. Payne JH, Yellin AE (1982) Traumatic diaphragmatic hernia. Arch Surg 117:18–24Google Scholar
  14. Rasiah KK, Crowe PJ (1995) Laparoscopic repair of a traumatic diaphragmatic hernia. J Laparoendosc Surg 5:405–7Google Scholar
  15. Shah R, Sabanathan S, Mearns AJ, Choudhury AK (1995) Traumatic rupture of diaphragm. Ann Thorac Surg 60:1444–1449Google Scholar
  16. Shackleton KL, Stewart ET, Taylor AJ (1998) Traumatic diaphragmatic injuries: spectrum of radiographic findings. Radiographics 18:49–59Google Scholar
  17. Shires GT, Thal ER, Jones RJ, Shires GT, Perry MO (1994) Trauma. In: Schwartz SI, Shires GT, Spencer FC, Husser WC (eds) Principles of Surgery 6th ed. McGraw-Hill Inc, New York, pp 175–225Google Scholar
  18. Simon RJ, Ivatury RR (1985) Current concepts in the use of cavitary endoscopy in the evaluation and treatment of blunt and penetrating truncal injuries Surg Clin N Amer 75:157–174Google Scholar
  19. Symbas PN, Vlasis SE, Hatcher C (1986) Blunt and penetrating diaphragmatic injuries with or without herniation of organs into the chest. Ann Thorac Surg 42:158–162Google Scholar
  20. Troop B, Myers RM, Agarwal NN (1985) Early recognition of diaphragmatic injuries from blunt trauma. Ann Emerg Med 14:97–101Google Scholar

Copyright information

© Springer-Verlag 2001

Authors and Affiliations

  • T. Z. Nursal
    • 1
    Email author
  • M. Ugurlu
    • 2
  • M. Kologlu
    • 2
  • E. Hamaloglu
    • 2
  1. 1.General Surgery Department Dr. Turgut Noyan Research HospitalBaskent UniversityAdanaTurkey
  2. 2.General Surgery DepartmentHacettepe University HospitalAnkaraTurkey

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