Pediatric Surgery International

, Volume 28, Issue 7, pp 687–691 | Cite as

Traumatic diaphragmatic hernia in children

Original Article

Abstract

Background

Traumatic diaphragmatic hernia (TDH) is very rare in the pediatric age group. Because of its rarity and its coexistence with more serious injuries, the diagnosis is often missed or delayed.

Patients and methods

All children with the diagnosis of TDH were retrospectively reviewed for age at diagnosis, sex, mechanism of injury, site of diaphragmatic rupture, associated injuries, injury severity score, investigations, treatment and outcome.

Results

Over a period of 15 years (1992–2007), we treated seven children with TDH. All were males except one. Their mean age was 7.4 years (3.75–14 years). The site of TDH was on the left in three, on the right in three and one had bilateral TDH. The mechanism of injury was blunt trauma in six and penetrating injury from a stab in one. Three had right TDH and in all three, the diagnosis of TDH was delayed. All sustained severe injuries as reflected by the ISS score (mean 38.6). The time from presentation to diagnosis was variable ranging from 3 to 240 h (mean 65.7 h). The three patients with left TDH were repaired trans-abdominally while the three with right TDH were repaired via a right thoracotomy. The patient with bilateral TDH required laparotomy and thoracotomy. All our patients survived and the hospital stay was variable ranging from 7 to 24 days (mean 17 days).

Conclusions

TDH is very rare in children and often associated with severe more serious injuries. These two factors contribute to the delay in diagnosis. This is specially so for right TDH. To obviate delay in diagnosis, it is important to have a high index of suspicion as well as careful interpretation of the initial and follow-up radiological investigations including CT-scan of the chest and abdomen. This is important to detect a slowly increasing TDH that may not be apparent initially.

Keywords

Trauma Ruptured diaphragm 

References

  1. 1.
    CT Ramos, Koplewitz BZ, Babyn PS, Manson D, Ein SH (2000) What have we learned about traumatic diaphragmatic hernias in children? J Pediatr Surg 35:601–604CrossRefGoogle Scholar
  2. 2.
    Brandt ML, Luks FI, Spigland NA, Lorenzo M, Laberge JM, Ouimet L (1992) Diaphragmatic injury in children. J Trauma 32:298–301PubMedCrossRefGoogle Scholar
  3. 3.
    Cywes S, Bass DH, Rode H, Millar AJW (1990) Blunt abdominal trauma in children. Pediatr Surg Int 5:350–354Google Scholar
  4. 4.
    Brown RA, Bass DH, Grant HW, Cywes S (1991) Blunt trauma causing diaphragmatic rupture in children. Pediatr Surg Int 6:345–347CrossRefGoogle Scholar
  5. 5.
    Antao B, Lansdale N, Shawis R (2006) Traumatic rupture of right hemidiaphragm in a child. Eur J Pediatr Surg 16:352–354PubMedCrossRefGoogle Scholar
  6. 6.
    Friedlaender E, Tsarouhas N (2003) Traumatic diaphragmatic rupture in a pediatric patient: a case report. Pediatr Emerg Care 19:340–342PubMedCrossRefGoogle Scholar
  7. 7.
    Baker SP, O’Neil B, Haddon W, Long W (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency cases. J Trauma 44:187–196CrossRefGoogle Scholar
  8. 8.
    Committee on injury scaling (1980) The abbreviated injury scale. 1980 Revision, Park Ridge, IL, American Association for Automotive MedicineGoogle Scholar
  9. 9.
    Peelet MH, Newman KD, Eichelberger MR, Gostschall CS, Guzzetta PC, Anderson KD (1990) Patterns of injury in children. J Pediatr Surg 36:85–91Google Scholar
  10. 10.
    Nehimi A, Szapiro D, Ghaye B et al (2005) Helical CT of blunt diaphragmatic rupture. Am J Roentgenol 184:24–30Google Scholar
  11. 11.
    Catasca JV, Siegel MJ (1995) Posttraumatic diaphragmatic hernia: CT findings in two children. Pediatr Radiol 25:262–264PubMedCrossRefGoogle Scholar
  12. 12.
    Steinau G, Bosman D, Dreuw B, Schumpelick V (1997) Diaphragmatic injuries—classification, diagnosis and therapy. Chirurg 68:509–512PubMedCrossRefGoogle Scholar
  13. 13.
    Alper B, Vargun R, Kologlu MB et al (2007) Late presentation of a traumatic rupture of the diaphragm with gastric volvulus in a child: report of a case. Surg Today 37:874–877PubMedCrossRefGoogle Scholar
  14. 14.
    Ugazzi M, Chiriboga A (1996) Laparoscopic treatment of incarcerated posttraumatic diaphragmatic hernia. J Laparoendosc Surg 6(Suppl 1):S83–S88PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Department of Pediatric SurgeryMaternity and Children HospitalQatifSaudi Arabia

Personalised recommendations