Abstract
The aim of this retrospective study is to review our experience in the diagnosis and role of thoracotomy for traumatic diaphragmatic hernia (TDH). Between January 2008 and June 2014, 23 patients from Yangzhou Medical College (Yangzhou China) and Lishui Center Hospital (Lishui China), who underwent thoracotomy for TDH, were analyzed. The clinical features, imaging findings, operative findings, and outcome of treatment in these patients are presented. There were 23 patients (18 males and 5 females) who underwent surgical procedures due to TDH. The median age of the patients was 43.2 years (range, 15–68 years). The cause of rupture was penetrating trauma in 1 (4.3 %) patient and blunt trauma in 22 (95.7 %) patients. The TDH was left sided in 21 patients and right sided in two patients. The diagnosis was made by chest X-ray (n = 2) and chest or abdominal CT (n = 13) and at thoracotomy based on a high index of suspicion (n = 8). Associated injuries were seen in 21 patients (91.3 %). Twenty-two patients underwent thoracotomy, and one underwent thoracotomy with laparotomy. The mean operating time was 112 min (range, 60–185 min) and the mean blood loss was 116 mL (range, 20–400 mL). The most common herniated organs were the omentum (n = 15), stomach (n = 14), spleen (n = 11), colon (n = 10), small bowel (n = 2), and liver (n = 1). All diaphragmatic defects were repaired using interrupted prolene sutures. The overall mortality rate was 4.3 % (n = 1). The diagnosis of TDH is easily missed or delayed. Chest X-ray and computer tomography (CT), especially chest and abdominal CT, are useful in the diagnosis of diaphragmatic ruptures, and thoracotomy is an effective and successful treatment for TDH.
Similar content being viewed by others
Reference
Kishore GS, Gupta V, Doley RP et al (2010) Traumatic diaphragmatic hernia: tertiary centre experience. Hernia 14(2):159–164
Turhan K, Makay O, Cakan A et al (2008) Traumatic diaphragmatic rupture: look to see. Eur J Cardiothorac Surg 33(6):1082–1085
Peer SM, Devaraddeppa PM, Buggi S (2009) Traumatic diaphragmatic hernia—our experience. Int J Surg 7(6):547–549
Al-Salem AH (2012) Traumatic diaphragmatic hernia in children. Pediatr Surg Int 28(7):687–691
Chughtai T, Ali S, Sharkey P et al (2009) Update on managing diaphragmatic rupture in blunt trauma: a review of 208 consecutive cases. Can J Surg 52(3):177–181
Shanmuganathan K, Killeen K, Mirvis SE et al (2000) Imaging of diaphragmatic injuries. J Thorac Imaging 15(2):104–111
Killeen KL, Mirvis SE, Shanmuganathan K (1999) Helical CT of diaphragmatic rupture caused by blunt trauma. AJR Am J Roentgenol 173(6):1611–1616
Larici AR, Gotway MB, Litt HI et al (2002) Helical CT with sagittal and coronal reconstructions: accuracy for detection of diaphragmatic injury. AJR Am J Roentgenol 179(2):451–457
Zubaidah NH, Azuawarie A, Ong KW et al (2015) Combined laparoscopic and thoracoscopic repair of a large traumatic diaphragmatic hernia: a case report. Med J Malaysia 70(2):108–109
Kuy S, Juern J, Weigelt JA (2014) Laparoscopic repair of a traumatic intrapericardial diaphragmatic hernia. JSLS 18(2):333–337
Safdar G, Slater R, Garner JP (2013) Laparoscopically assisted repair of an acute traumatic diaphragmatic hernia. BMJ Case Rep
Latic F, Delibegovic S, Latic A et al (2010) Laparoscopic repair of traumatic diaphragmatic hernia. Med Arh 64(2):121–122
Parelkar SV, Oak SN, Patel JL et al (2012) Traumatic diaphragmatic hernia: management by video assisted thoracoscopic repair. J Indian Assoc Pediatr Surg 17(4):180–183
Haciibrahimoglu G, Solak O, Olcmen A et al (2004) Management of traumatic diaphragmatic rupture. Surg Today 34(2):111–114
Soundappan SV, Holland AJ, Cass DT et al (2005) Blunt traumatic diaphragmatic injuries in children. Injury 36(1):51–54
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Additional information
Zhang Fangbiao, Zheng Chunhui, Zhao Chun and Shi Hongcan contributed equally to this work.
Rights and permissions
About this article
Cite this article
Fangbiao, Z., Chunhui, Z., Chun, Z. et al. Thoracotomy for Traumatic Diaphragmatic Hernia. Indian J Surg 78, 371–374 (2016). https://doi.org/10.1007/s12262-016-1484-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12262-016-1484-z