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Complicated Diaphragmatic Hernia in Emergency Surgery: Systematic Review of the Literature

World Journal of Surgery volume 44, pages 4012–4031 (2020)Cite this article

Abstract

Introduction

Complicated diaphragmatic hernia (DH) can be congenital or acquired. Congenital diaphragmatic hernias (CDH) are rare and often can be asymptomatic until adulthood. Traumatic diaphragmatic hernia (TDH) is a complication that occurs in about 1–5% of victims of road accidents and in 10–15% of penetrating traumas of the lower chest. CDH and TDH are potentially life-threatening conditions, and the management in emergency setting still debated. This study aims to evaluate the surgical treatment options in emergency setting.

Methods

A bibliographic research reporting the item “emergency surgery” linked with “traumatic diaphragmatic rupture” and “congenital diaphragmatic hernia” was performed. Several parameters were recorded including sex, age, etiology, diagnosis, treatment, site and herniated organs.

Results

The research included 146 articles, and 1542 patients were analyzed. Most of the complicated diaphragmatic hernias occurred for a diaphragmatic defect due to trauma, only 7.2% occurred for a congenital diaphragmatic defect. The main diagnostic method used was chest X-ray and CT scan. Laparotomic approach still remains predominant compared to the minimally invasive approach.

Conclusion

Surgery is the treatment of choice and is strongly influenced by the preoperative setting, performed mainly with X-ray and CT scan. Minimally invasive approach is safe and feasible but is highly dependent on the surgeon's expertise, especially in emergency setting.

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Fig. 1
Fig. 2

Abbreviations

DH:

Diaphragmatic hernia

CDH:

Congenital diaphragmatic hernia

ADH:

Acquired diaphragmatic hernia

MH:

Morgagni’s hernia

TDH:

Traumatic diaphragmatic hernia

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  1. Department of Emergency Surgery, Parma University Hospital, Parma, Italy

    Gennaro Perrone & Fausto Catena

  2. General Surgery Unit, Department of Medicine and Surgery, Parma University Hospital, Via A. Gramsci 14, 43126, Parma, Italy

    Mario Giuffrida, Alfredo Annicchiarico, Elena Bonati & Paolo Del Rio

  3. Department of Biomedical Sciences and Human Oncology, Unit of Endocrine, Digestive and Emergency Surgery, University Medical School of Bari, Bari, Italy

    Mario Testini

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Perrone, G., Giuffrida, M., Annicchiarico, A. et al. Complicated Diaphragmatic Hernia in Emergency Surgery: Systematic Review of the Literature. World J Surg 44, 4012–4031 (2020). https://doi.org/10.1007/s00268-020-05733-6

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