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Hernia

, Volume 8, Issue 4, pp 393–396 | Cite as

Delayed traumatic diaphragmatic hernias presenting with strangulation

  • O. Alimoglu
  • R. Eryilmaz
  • M. Sahin
  • M. S. Ozsoy
Case Report

Abstract

Traumatic diaphragmatic injuries commonly occur following blunt and penetrating trauma, and that may be missed during a first evaluation, resulting in chronic diaphragmatic hernia and/or strangulation. In this study, we present three cases of delayed traumatic diaphragmatic hernias presenting with strangulation. The type of trauma was blunt in two and penetrating in one patient. In all three cases, the diagnoses of diaphragmatic injuries were missed in acute and chronic settings. While two patients had transverse colonic strangulation, the other one had strangulated stomach and spleen. Transverse colon resection was performed in one patient. Two patients had postoperative complications, and no postoperative mortality was detected. Patients complaining of upper abdominal pain and dyspnea with past history of thoracoabdominal trauma should be evaluated for a missed diaphragmatic injury. A high index of suspicion, physical examination of the chest, and x-ray film are helpful for diagnosis of delayed traumatic diaphragmatic hernias presenting with strangulation.

Keywords

Trauma Diaphragmatic injury Delayed diagnosis Hernia Strangulation 

References

  1. 1.
    Reina A, Vidana E, Soriano P, Orte A, Ferrer M, Herrera E, Lorenzo M, Torres J, Belda R (2001) Traumatic intrapericardial diaphragmatic hernia: case report and literature review. Injury 32:153–156CrossRefPubMedGoogle Scholar
  2. 2.
    Moore JB, Moore EE, Thompson JS (1980) Abdominal injuries associated with penetrating trauma in the lower chest. Am J Surg 140:724–730PubMedGoogle Scholar
  3. 3.
    Madden MR, Paull DE, Finkelstein JL, Goodwin CW, Marzulli V, Yurt RW, Shires GT (1989) Occult diaphragmatic injury from stab wounds to the lower chest and abdomen. J Trauma 29:292–298PubMedGoogle Scholar
  4. 4.
    Steinau G, Dreuw B, Schleef J, Treutner KH, Schumpelick V (1997) Diaphragm replacement: An experimental animal study. Hernia 1:123–127Google Scholar
  5. 5.
    Christophi C (1983) Diagnosis of traumatic diaphragmatic hernia: analysis of 63 cases. World J Surg 7:277–280PubMedGoogle Scholar
  6. 6.
    Payne JH Jr, Yellin AE (1982) Traumatic diaphragmatic hernia. Arch Surg 117: 18–24PubMedGoogle Scholar
  7. 7.
    Kuhn R, Schubert D, St Wolff, Marusch F, Lippert H, Pross M (2002) Repair of diaphragmatic rupture by laparoscopic implantation of a polytetrafluoroethylene patch. Surg Endosc 16:1495CrossRefGoogle Scholar
  8. 8.
    Vermillion JM, Wilson EB, Smith RW (2001) Traumatic diaphragmatic hernia presenting as a tension fecopneumothorax. Hernia 5:158–160PubMedGoogle Scholar
  9. 9.
    Demetriades D, Kakoyiannis S, Parekh D, Hatzitheofilou C (1988) Penetrating injuries of the diaphragm. Br J Surg 75:824–826PubMedGoogle Scholar
  10. 10.
    Nursal TZ, Ugurlu M, Kologlu M, Hamaloglu E (2001) Traumatic diaphragmatic hernias: A report of 26 cases. Hernia 5:25–29PubMedGoogle Scholar
  11. 11.
    Killeen KL, Mirvis SE, Shanmuganathan K (1999) Helical CT of diaphragmatic rupture caused by blunt trauma. AJR Am J Roentgenol 173:1611–1616PubMedGoogle Scholar
  12. 12.
    Hood RM. (1971) Traumatic diaphragmatic hernia. Ann Thorac Surg 12:311–324PubMedGoogle Scholar
  13. 13.
    Thillois JM, Tremblay B, Cerceau E, Dehaye B, Gigou F, Destable MD, Azorin JF (1998) Traumatic rupture of the right diaphragm. Hernia 2:119–121Google Scholar
  14. 14.
    Shah R, Sabanathan S, Mearns AJ, Choudhury AK (1995) Traumatic rupture of diaphragm. Ann Thorac Surg 60:1444–1449PubMedGoogle Scholar
  15. 15.
    Sharma OP (1989) Traumatic diaphragmatic rupture: not an uncommon entity--personal experience with collective review of the 1980’s. J Trauma 29:678–682PubMedGoogle Scholar
  16. 16.
    Lee WC, Chen RJ, Fang JF, Wang CC, Chen HY, Chen SC, Hwang TL, Jeng LB, Jan YY, Wang CS (1994) Rupture of the diaphragm after blunt trauma. Eur J Surg 160:479–483PubMedGoogle Scholar
  17. 17.
    Guth AA, Pachter HL, Kim U (1995) Pitfalls in the diagnosis of blunt diaphragmatic injury. Am J Surg 170:5-9PubMedGoogle Scholar
  18. 18.
    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
  19. 19.
    Schumpelick V, Steinau G, Schluper I, Prescher A (2000) Surgical embryology and anatomy of the diaphragm with surgical applications. Surg Clin North Am 80:213–239Google Scholar
  20. 20.
    Worthy SA, Kang EY, Hartman TE, Kwong JS, Mayo JR, Muller NL (1995) Diaphragmatic rupture: CT findings in 11 patients. Radiology 194: 885–888PubMedGoogle Scholar
  21. 21.
    Bergin D, Ennis R, Keogh C, Fenlon HM, Murray JG (2001) The “dependent viscera” sign in CT diagnosis of blunt traumatic diaphragmatic rupture. AJR Am J Roentgenol 177:1137–1140PubMedGoogle Scholar
  22. 22.
    Feliciano DV, Cruse PA, Mattox KL, Bitondo CG, Burch JM, Noon GP, Beall AC Jr. (1988) Delayed diagnosis of injuries to the diaphragm after penetrating wounds. J Trauma 28:1135–1144PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • O. Alimoglu
    • 1
    • 2
  • R. Eryilmaz
    • 1
  • M. Sahin
    • 1
  • M. S. Ozsoy
    • 1
  1. 1.First Department of SurgeryVakif Gureba Training HospitalIstanbulTurkey
  2. 2.Kazimkarabekir Mah. Hekim Suyu CadIstanbulTurkey

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