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Hernia

, Volume 9, Issue 4, pp 392–396 | Cite as

Chronic traumatic diaphragmatic hernia with pericardial rupture and associated gastroesophageal reflux

  • B. E. Wright
  • T. Reinke
  • R. W. AyeEmail author
Case Report

Abstract

Major thoracic and abdominal trauma damages the diaphragm 5% of the time. These injuries may be recognized when they occur but often are discovered months later during work up for related symptoms. Typically, the injury is to the left posterolateral aspect of the diaphragm. Rarely, rupture through the central diaphragmatic tendon into the pericardial space occurs and this results in different symptoms than the more common injury. We present the case of a patient who presented with chest pain, near syncopal episodes and refractory gastroesophageal reflux years after he was struck by a car and hospitalized. Radiographic imaging included a chest CT that demonstrated herniation of the transverse colon into the mediastinum. During exploration, a defect in the central diaphragm was found with free communication between the peritoneal and pericardial spaces. In this paper, we review our management of this unusual diaphragmatic hernia and the unique symptoms associated with it.

Keywords

Diaphragm Hernia Trauma Pericardial GERD 

References

  1. 1.
    Meyers BF, McCabe CJ (1993) Traumatic diaphragmatic hernia: occult marker of serious injury. Ann Surg 218:783–790PubMedCrossRefGoogle Scholar
  2. 2.
    De La Rocha AG, Creel RJ, Mulligan GW, Burns CM (1982) Diaphragmatic rupture due to blunt abdominal trauma. Surg Gynecol Obstet 154:175–180PubMedGoogle Scholar
  3. 3.
    Ward RE, Flynn TC, Clark WP (1981) Diaphragmatic disruption secondary to blunt abdominal trauma. J Trauma 21:35–38PubMedCrossRefGoogle Scholar
  4. 4.
    Nursal TZ, Ugurlu M, Kologlu M, Hamaloglu E (2001) Traumatic diaphragmatic hernias: a report of 26 cases. Hernia 5:25–29CrossRefPubMedGoogle Scholar
  5. 5.
    Losanoff JE, Sauter ER (2004) Congenital posterolateral diaphragmatic hernia in an adult. Hernia 8:83–85CrossRefPubMedGoogle Scholar
  6. 6.
    Van Loenhout RM, Schiphost TJ, Wittens CH, Pinckaers JA (1986) Traumatic intrapericardial diaphragmatic hernia. J Trauma 26:271–275PubMedCrossRefGoogle Scholar
  7. 7.
    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
  8. 8.
    Girzadas DV, Fligner DJ (1991) Delayed traumatic intrapericardial diaphragmatic hernia associated with cardiac tamponade. Ann Emerg Med 20:55CrossRefPubMedGoogle Scholar
  9. 9.
    Jackson PG, Gleiber MA, Askari R, Evans SR (2001) Predictors of outcome in one hundred consecutive laparoscopic antireflux procedures. Am J Surg 181:231–235CrossRefPubMedGoogle Scholar
  10. 10.
    Fleyfel M, Ferreira JF, Gonzalez de Linares H, Merlier O, Harchaoui A (1994) Cardiac tamponade after intrapericardial diaphragmatic hernia. Br J Anaesth 73:249–251PubMedCrossRefGoogle Scholar
  11. 11.
    Meng RL, Straus A, Milloy F, Kittle CF, Langston H (1979) Intrapericardial diaphragmatic hernia in adults. Ann Surg 189:359–366PubMedCrossRefGoogle Scholar
  12. 12.
    Settembre A, Cuccurullo D, Pisaniello D, Capasso P, Miranda L, Corcione F (2003) Laparoscopic repair of congenital diaphragmatic hernia with prosthesis: a case report. Hernia 7:52–54PubMedGoogle Scholar
  13. 13.
    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

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  1. 1.Department of General, Thoracic and Minimally Invasive SurgerySwedish Medical CenterSeattleUSA

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