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Traumatic diaphragmatic hernia—17 years experience

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Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Background

Objective of this study is to review our experience in the management of traumatic diaphragmatic hernias over 17 years.

Methods

Following Ethical Committee clearance, records of all patients who underwent traumatic diaphragmatic hernia surgery at Shanthabai Devarao Shivaram (SDS) Tuberculosis Research Centre and Rajiv Gandhi Institute of Chest Diseases, Bengaluru, India from January 1998 to December 2015 were reviewed. Data collected and analyzed were clinical presentation, mode of diagnosis, intraoperative findings and the postoperative clinical outcomes.

Results

Sixty patients underwent traumatic diaphragmatic hernia repair during this period. Age ranged between 10 and 80 years. The most common presentation was dyspnea. Blunt trauma was the cause in 52 (86.67%) cases and penetrating trauma in 8 (13.33%) cases. The diagnosis was within 24 h in 45 (75%) cases and in 15 (25%) cases the diagnosis was made after 24 h. Thoracotomy was the preferred approach for the repair in the absence of associated abdominal injuries. The most common site of rupture was the central tendon. The perioperative mortality was 8.33%. The hospital stay ranged between 5 and 84 days (mean 22 days).

Conclusion

Right-sided diaphragmatic hernias are notorious to be missed on initial evaluation. Despite advances in diagnostic modalities, chest X-ray still continues to be useful in the diagnosis of traumatic ruptures. A high index of suspicion, together with the knowledge of mechanism of trauma is the key factor for the correct diagnosis.

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References

  1. Rubikas R. Diaphragmatic injuries. Eur J Cardio-thorac Surg. 2001;20:53–7.

    Article  CAS  Google Scholar 

  2. Hanna Wael C, Ferri Lorenzo E, Fata P, Razek T, Mulder DS. The current status of traumatic diaphragmatic injury: Lessons learned from 105 patients over 13 years. Ann Thorac Surg. 2008;85:1044–8.

    Article  CAS  PubMed  Google Scholar 

  3. Rossetti G, Brusciano L, Maffetone V, et al. Giant right post-traumatic diaphragmatic hernia: laparoscopic repair without a mesh. Chir Ital. 2005;57:243–6.

    PubMed  Google Scholar 

  4. Pappas-Gogos G, Karfis E, Kakadellis J, Tsimoyiannis EC. Intrathoracic cancer of the splenic flexure. Hernia. 2007;11:257–9.

    Article  CAS  PubMed  Google Scholar 

  5. DeBlasio R, Maione P, Avallone U, Rossi M, Pigna F, Napolitano C. Late posttraumatic diaphragmatic hernia. A clinical case report. Minerva Chir. 1994;49:481–7.

    CAS  Google Scholar 

  6. Sangster G, Ventura VP, Carbo A, Gates T, Garayburu J, D'Agostino H. Diaphragmatic rupture: a frequently missed injury in blunt thoracoabdominal trauma patients. Emerg Radiol. 2007;13:225–30.

    Article  CAS  PubMed  Google Scholar 

  7. Walchalk LR, Stanfield SC. Delayed Presentation of Traumatic Diaphragmatic Rupture. J Emerg Med. 2010;39:21–4.

    Article  PubMed  Google Scholar 

  8. Kulstad EB, Pisano MV, Shirakbari AA. Delayed presentation of traumatic diaphragmatic hernia. J Emerg Med. 2003;24:455–7.

    Article  PubMed  Google Scholar 

  9. Mintz Y, Easter DW, Izhar U, Edden Y, Talamini MA, Rivkind AI. Minimally invasive procedures for diagnosis of traumatic right diaphragmatic tears: a method for correct diagnosis in selected patients. Am Surg. 2007;73:388–92.

    PubMed  Google Scholar 

  10. Faul JL. Diaphragmatic rupture presenting forty years after injury. Injury. 1998;29:479–80.

    Article  CAS  PubMed  Google Scholar 

  11. Goh BK, Wong AS, Tay KH, Hoe MN. Delayed presentation of a patient with a ruptured diaphragm complicated by gastric incarceration and perforation after apparently minor blunt trauma. Canadian J Emer Med. 2004;6:277–80.

    Google Scholar 

  12. Sirbu H, Busch T, Spillner J, Schachtrupp A, Autschbach R. Late bilateral diaphragmatic rupture: challenging diagnostic and surgical repair. Hernia. 2005;9:90–2.

    Article  CAS  PubMed  Google Scholar 

  13. Al-Mashat F, Sibiany A, Kensarah A, Eibany K. Delayed presentation of traumatic diaphragmatic rupture. Indian J Chest Dis Allied Sci. 2002;44:121–4.

    PubMed  Google Scholar 

  14. Singh S, Kalan MM, Moreyra CE, Buckman RF Jr. Diaphragmatic rupture presenting 50 years after the traumatic event. J Trauma. 2000;49:156–9.

    Article  CAS  PubMed  Google Scholar 

  15. Symbas PN, Vlasis SE, Hatcher C Jr. Blunt and penetrating diaphragmatic injuries with or without herniation of organs into the chest. Ann Thorac Surg. 1986;42:158–62.

    Article  CAS  PubMed  Google Scholar 

  16. Turhan K, Makay O, Cakan A, et al. Traumatic diaphragmatic rupture: look to see. Eur J Cardiothorac Surg. 2008;33:1082–5.

    Article  PubMed  Google Scholar 

  17. Athanassiadi K, Kalavrouziotis G, Athanassiou M, Vernikosc P, Skrekasd G, Poultsidie A. Blunt diaphragmatic rupture. Eur J Cardiothorac Surg. 1999;15:469–74.

    Article  CAS  PubMed  Google Scholar 

  18. Kucuk HF, Demirhan R, Kurt N, Ozyurt Y, Topaloğlu I, Gülmen M. Traumatic diaphragmatic rupture: analysis of 48 cases. Ulus Travma Derg. 2002;8:94–7.

    PubMed  Google Scholar 

  19. Gelman R, Mirvis SE, Gens D. Diaphragmatic rupture due to blunt trauma: sensitivity of plain chest radiographs. AJR Am J Roentgenol. 1991;156:51–7.

    Article  CAS  PubMed  Google Scholar 

  20. Shanmuganathan K, Mirvis SE. Imaging diagnosis of nonaortic thoracic injury. Radiol Clin North Am. 1999;37:533–51.

    Article  CAS  PubMed  Google Scholar 

  21. Ala-Kulju K, Verkkala K, Ketonen P, Harjola P-T. Traumatic rupture of the right hemidiaphragm. Stand J Thorac Cardiovasc Surg. 1986;20:109–14.

    Article  CAS  Google Scholar 

  22. Kuhlman JE, Pozniak MA, Collins J, Knisely BL. Radiographic and CT findings of blunt chest trauma: Aortic injuries and looking beyond them. Radiographics. 1998;18:1085–106.

    Article  CAS  PubMed  Google Scholar 

  23. Feliciano DV, Cruse PA, Mattox KL, et al. Delayed diagnosis of injuries to the diaphragm after penetrating wounds. J Trauma. 1988;28:1135–44.

    Article  CAS  PubMed  Google Scholar 

  24. Nchimi A, Szapiro D, Ghaye B, et al. Helical CT of blunt diaphragmatic rupture. AJR Am J Roentgenol. 2005;184:24–30.

    Article  PubMed  Google Scholar 

  25. Dosios T, Papachristos IC, Chrysicopoulos H. Magnetic resonance imaging of blunt traumatic rupture of the right hemidiaphragm. Eur J Cardio-thorac Surg. 1993;7:553–4.

    Article  CAS  Google Scholar 

  26. Iwasaki M, Inoue H. Traumatic injuries of the diaphragm. Kyobu Geka. 2004;57:795–9.

    PubMed  Google Scholar 

  27. Tiberio GA, Portolani N, Coniglio A, Baiocchi GL, Vettoretto N, Giulini SM. Traumatic lesions of the diaphragm. Our experience in 33 cases and review of the literature. Acta Chir Belg. 2005;105:82–8.

    CAS  PubMed  Google Scholar 

  28. Shanmuganathan K, Mirvis SE, White CS, Pomerantz SM. MR imaging evaluation of hemidiaphragms in acute blunt trauma: experience with 16 patients. AJR Am J Roentgenol. 1996;167:397–402.

    Article  CAS  PubMed  Google Scholar 

  29. Spann JC, Nwariaku FE, Wait M. Evaluation of video-assisted thoracoscopic surgery in the diagnosis of diaphragmatic injuries. Am J Surg. 1995;170:628–30.

    Article  CAS  PubMed  Google Scholar 

  30. Matz A, Alis M, Charuzi I, Kyzer S. The role of laparoscopy in the diagnosis and treatment of missed diaphragmatic rupture. Surg Endosc. 2000;14:537–9.

    Article  CAS  PubMed  Google Scholar 

  31. Ben-Nun A, Orlovsky M, Best LA. Video-assisted thoracoscopic surgery in the treatment of chest trauma: Long-term benefit. Ann Thorac Surg. 2007;83:383–7.

    Article  PubMed  Google Scholar 

  32. Shah R, Sabanathan S, Mearns AJ, Choudhury AK. Traumatic rupture of diaphragm. Ann Thorac Surg. 1995;60:1444–9.

    Article  CAS  PubMed  Google Scholar 

  33. Niville EC, Himpens JM, Bruos PL, Gruwez JA. The use of laparotomy in the treatment of recent diaphragmatic rupture due to blunt trauma. Injury. 1983;15:153–5.

    Article  CAS  PubMed  Google Scholar 

  34. McCune RP, Roda CP, Eckert C. Rupture of the diaphragm caused by blunt trauma. J Trauma. 1976;16:531–7.

    Article  CAS  PubMed  Google Scholar 

  35. Johnson CD. Blunt injuries of the diaphragm. Br J Surg. 1988;75:226–30.

    Article  CAS  PubMed  Google Scholar 

  36. Galan G, Penalver JC, Paris F, et al. Blunt chest injuries in 1696 patients. Eur J Cardiothorac Surg. 1992;6:284–7.

    Article  CAS  PubMed  Google Scholar 

  37. Tsuda M, Ichiki K, Doki Y, Yamashita S, Misaki T, Sugiyama S. Thoracic surgical approach for traumatic diaphragmatic hernia. Kyobu Geka. 2004;57:949–52.

    PubMed  Google Scholar 

  38. Naumheim KS. Adult presentation of unusual diaphragmatic hernias. Chest Surg Clin North Am. 1998;8:359–69.

    Google Scholar 

  39. Haciibrahimoglu G, Solak O, Olcmen A, Berinhan MA, Solmazer N, Gurses A. Management of traumatic diaphragmatic rupture. Surg Today. 2004;34:111–4.

    Article  PubMed  Google Scholar 

  40. Esme H, Solak O, Sahin DA, Sezer M. Blunt and penetrating traumatic ruptures of the diaphragm. Thorac Cardiovasc Surg. 2006;54:324–7.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. #25, Kausthubha Kuteera, 9th cross K R Layout, J P Nagar 6th phase, Bengaluru, Karnataka, 560078, India

    Maruti Yamanappa Haranal

  2. Department of Cardio-Thoracic and Vascular Surgery, SDS Tuberculosis Research Centre and Rajiv Gandhi Institute of Chest Diseases, Bengaluru, Karnataka, India

    Maruti Yamanappa Haranal & Shashidhar Buggi

  3. Department of Anesthesia, SDS Tuberculosis Research Centre and Rajiv Gandhi Institute of Chest Diseases, Bengaluru, Karnataka, India

    Satyaprakash Sanjeevaiah & Venugopal Venkatappa

Authors
  1. Maruti Yamanappa Haranal
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  2. Shashidhar Buggi
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  3. Satyaprakash Sanjeevaiah
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  4. Venugopal Venkatappa
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Correspondence to Maruti Yamanappa Haranal.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Haranal, M.Y., Buggi, S., Sanjeevaiah, S. et al. Traumatic diaphragmatic hernia—17 years experience. Indian J Thorac Cardiovasc Surg 34, 38–43 (2018). https://doi.org/10.1007/s12055-017-0534-x

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  • DOI: https://doi.org/10.1007/s12055-017-0534-x

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