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World Journal of Surgery

, Volume 36, Issue 2, pp 260–265 | Cite as

Management of Delayed Presentation of a Right-Side Traumatic Diaphragmatic Rupture

  • Ali Guner
  • Omer Faruk Ozkan
  • Yildiray Bekar
  • Can Kece
  • Umit Kaya
  • Erhan Reis
Article

Abstract

Background

Right-side diaphragmatic rupture is an unusual condition after blunt trauma. The diagnosis may be missed during the early period of trauma and may lead to progressive herniation of intraabdominal contents into the thorax. In this study, we aimed to evaluate the diagnosis and treatment options for the late diagnosis of cases of right-side traumatic diaphragmatic rupture.

Methods

We evaluated the patients with diaphragmatic hernia who were admitted to the hospital during an 8-year period. Only patients with a right-side diaphragmatic hernia and a history of high-energy trauma were included in the study. Patients with left-side diaphragmatic hernia or those who were subjected to emergency operation due to diaphragmatic rupture were excluded from the study. Patient characteristics, clinical presentations, diagnostic tools, and treatment options were evaluated.

Results

Eight patients (five men, three women) were enrolled in the study. The most common trauma type was a traffic accident, and the average interval between the trauma and diagnosis was 10 years. Thoracoabdominal computed tomography had high sensitivity and specificity for visualizing the diaphragmatic hernia. No predisposing factor was found to add laparotomy to thoracotomy. There was no postoperative mortality, and no late complications were observed at the assessments during the 45-month follow-up.

Conclusions

Clinical presentation of late diagnosed diaphragmatic hernia, which is encountered only rarely on the right side, requires diagnostic and therapeutic approaches different from those associated with acute diaphragmatic rupture. It should not be forgotten during the differential diagnosis in patients with a history of trauma.

Keywords

Diaphragmatic Hernia Blunt Trauma Diaphragmatic Rupture Laparotomy Group Diagnostic Imaging Modality 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Conflicts of interest

The authors report no potential or real conflicts of interest.

References

  1. 1.
    Bader FG, Hoffmann M, Laubert T et al (2009) Hepatothorax after right-sided diaphragmatic rupture mimicking a pleural effusion: a case report. Cases J 2:8545PubMedCrossRefGoogle Scholar
  2. 2.
    Guner A, Bekar Y, Kece C et al (2012) Delayed enterothorax and hepatothorax due to missed right-sided traumatic diaphragmatic rupture. Am J Emerg Med 30:263e10CrossRefGoogle Scholar
  3. 3.
    Mihos P, Potaris K, Gakidis J et al (2003) Traumatic rupture of the diaphragm: experience with 65 patients. Injury 34:169–172PubMedCrossRefGoogle Scholar
  4. 4.
    Rosati C (1998) Acute traumatic injury of the diaphragm. Chest Surg Clin N Am 8:371–379PubMedGoogle Scholar
  5. 5.
    Grimes OF (1974) Traumatic injuries of the diaphragm: diaphragmatic hernia. Am J Surg 128:175–181PubMedCrossRefGoogle Scholar
  6. 6.
    Goh BKP, Wong ASY, Tay KH et al (2004) Delayed presentation of a patient with a ruptured diaphragm complicated by gastric incarceration and perforation after apparently minor blunt trauma. CJEM 6:277–280PubMedGoogle Scholar
  7. 7.
    Rashid F, Chakrabarty MM, Singh R et al (2009) A review on delayed presentation of diaphragmatic rupture. World J Emerg Surg 21:32CrossRefGoogle Scholar
  8. 8.
    Popovic T, Nikolic S, Radovanovic B et al (2004) Missed diaphragmatic rupture and progressive hepatothorax, 26 years after blunt injury. Eur J Trauma 30:43–46CrossRefGoogle Scholar
  9. 9.
    Kotoulas C, Chouliaras E, Siarapis P et al (2004) Right diaphragmatic rupture and hepatic hernia: a rare late sequela of thoracic trauma. Eur J Cardiothorac Surg 25:1121PubMedCrossRefGoogle Scholar
  10. 10.
    Matsevych OY (2008) Blunt diaphragmatic rupture: four year’s experience. Hernia 12:73–78PubMedCrossRefGoogle Scholar
  11. 11.
    Chughtai T, Ali S, Sharkey P et al (2009) Update on managing diaphragmatic rupture in blunt trauma: a review of 208 consecutive cases. Can J Surg 52:177–181PubMedGoogle Scholar
  12. 12.
    Meyers BF, McCabe CJ (1993) Traumatic diaphragmatic hernia: occult marker of serious injury. Ann Surg 218:783–790PubMedCrossRefGoogle Scholar
  13. 13.
    Soro KG, Coulibaly A, Yapo P et al (2006) Outcome of undiagnosed traumatic diaphragmatic injuries: a review of our management. Niger J Surg Res 8:148–150Google Scholar
  14. 14.
    Turhan K, Makay O, Cakan A et al (2008) Traumatic diaphragmatic rupture: look to see. Eur J Cardiothorac Surg 33:1082–1085PubMedCrossRefGoogle Scholar
  15. 15.
    Alimoglu O, Eryilmaz R, Sahin M et al (2004) Delayed traumatic diaphragmatic hernias presenting with strangulation. Hernia 8:393–396PubMedCrossRefGoogle Scholar
  16. 16.
    Gelman R, Mirvis SE, Gens D (1991) Diaphragmatic rupture due to blunt trauma: sensitivity of plain chest radiographs. AJR Am J Roentgenol 156:51–57PubMedGoogle Scholar
  17. 17.
    Iochum S, Ludig T, Walter F et al (2002) Imaging of diaphragmatic injury: a diagnostic challenge? Radiographics 22:103–116Google Scholar
  18. 18.
    Sadeghi N, Nicaise N, DeBacker D et al (1999) Right diaphragmatic rupture and hepatic hernia: an indirect sign on computed tomography. Eur Radiol 9:972–974PubMedCrossRefGoogle Scholar
  19. 19.
    Murray JG, Caoili E, Gruden JF et al (1996) Acute rupture of the diaphragm due to blunt trauma: diagnostic sensitivity and specificity of CT. AJR Am J Roentgenol 166:1035–1039PubMedGoogle Scholar
  20. 20.
    Bergin D, Ennis R, Keogh C et al (2001) The “dependent viscera” sign in CT diagnosis of blunt traumatic diaphragmatic rupture. AJR Am J Roentgenol 177:1137–1140PubMedGoogle Scholar
  21. 21.
    Worthy SA, Kang EY, Hartman TE et al (1995) Diaphragmatic rupture: CT findings in 11 patients. Radiology 194:885–888PubMedGoogle Scholar
  22. 22.
    Haciibrahimoglu G, Solak O, Olcmen A et al (2004) Management of traumatic diaphragmatic rupture. Surg Today 34:111–114PubMedCrossRefGoogle Scholar
  23. 23.
    Igai H, Yokomise H, Kumagai K et al (2007) Delayed hepatothorax due to right-sided traumatic diaphragmatic rupture. Gen Thorac Cardiovasc Surg 55:434–436PubMedCrossRefGoogle Scholar
  24. 24.
    Wirbel RJ, Mutschler W (1998) Blunt rupture of the right hemi-diaphragm with complete dislocation of the right hepatic lobe: report of a case. Surg Today 8:850–852CrossRefGoogle Scholar
  25. 25.
    Thomas P, Moutardier V, Ragni J et al (1994) Video-assisted repair of a ruptured right hemidiaphragm. Eur J Cardiothorac Surg 8:157–159PubMedCrossRefGoogle Scholar
  26. 26.
    Schummer W, Schummer C, Gottschall et al (2003) Delayed diagnosis of right-sided diaphragmatic rupture. Accid Emerg Nurs 11:2–4PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2011

Authors and Affiliations

  • Ali Guner
    • 1
  • Omer Faruk Ozkan
    • 1
  • Yildiray Bekar
    • 2
  • Can Kece
    • 1
  • Umit Kaya
    • 1
  • Erhan Reis
    • 1
  1. 1.Department of General SurgeryTrabzon Numune Training and Research HospitalTrabzonTurkey
  2. 2.Department of Thoracic SurgeryTrabzon Numune Training and Research HospitalTrabzonTurkey

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