2006, Number 6
<< Back Next >>
Cir Cir 2006; 74 (6)
Diaphragmatic traumatic hernia
Olivares BJJ, Farías LOA, Candelas del TO, Medrano MF, Fuentes OC, González OA
Language: Spanish
References: 28
Page: 415-423
PDF size: 197.49 Kb.
ABSTRACT
Background: Traumatic diaphragmatic hernias commonly occur after blunt and penetrating trauma. Due to coexisting injuries and the silent nature of the diaphragmatic injuries, the diagnosis is easily missed. We undertook this study to describe the clinical characteristics of consecutive patients with traumatic diaphragmatic hernias treated surgically at our institution.
Methods: We conducted a prospective cohort of patients treated during a 6-year period. We assessed variables such as age, gender, type of mechanism of trauma, type of hernia, methods of diagnosis, herniated organs and associated lesions, time of evolution, morbidity and mortality. Results are described as frequencies, dispersion and central tendency measures. χ
2 and Fisher’s exact tests were used to explore association and risks.
Results: Twenty three patients were included, 19 men (82.6 %) and 4 women (17.4 %). Acute TDH were diagnosed in nine patients (39.1 %) and 14 cases presented as chronic TDH (60.9 %). In 18 cases (78.3 %) the diagnosis was made by chest x-ray and most corresponded to chronic hernias. Medical history of blunt thoracoabominal trauma was present in 95.7 % of the cases, most related to car accidents. The principal associated lesions were head injuries, rib fractures and lung contusion. Morbidity was observed in six patients, all with chronic hernias. There was no mortality.
Conclusions: DTH is a rare clinical entity and constitutes a true challenge due to difficulties for a rapid and correct diagnosis. In the chronic stage there is an increased risk for late complications such as visceral strangulation and necrosis.
REFERENCES
1. Reber PU, Schmied B, Seiler CA, Bear HU, Patel AG, Buchler MW. Missed diaphragmatic injuries and their long-term sequelae. J Trauma 1998;44:183-188.
2. Prieto RG, Zapata CM, Roa GA, Ponce AG. Hernia diafragmática traumática. Experiencia institucional. Rev Col Cir 1997;12:93-99.
3. Shah R, Sabanathan S, Mearns AJ, Choudhury AK. Traumatic rupture of the diaphragm. Ann Thorac Surg 1995;60:1444-1449.
4. Padilla-González MA, Guerrero-Guerrero VH, Ruiz-Galindo GH, Vizcarra-Díaz A. Trauma de diafragma: experiencia de 11 años en el Hospital Central Militar. Cir Gen 2001;23:229-233.
5. Degiannis E, Levy RD, Sofianos C, Potokar T, Florizoone MG, Saadia R. Diaphragmatic herniation after penetring trauma. Br J Surg 1996;83:88-91.
6. Mihos P, Potaris K, Gakidis J, et al. Traumatic rupture of the diaphragm: experience with 65 patients. Injury 2003;34:169-172.
7. Kaw LL, Potenza BM, Coimbra R, Hoyt DB. Traumatic diaphragmatic hernia. J Am Coll Surg 2004;198:668-669.
8. Cancino-Ahumada P. Hernias traumáticas del diafragma. Rev Chil Cir 2001;53:380-385.
9. Sung CK, Kim KH. Missed injuries in abdominal trauma. J Trauma 1996;41:276-282.
10. Kamelgard JI, Harris L, Reardon MJ, Reardon PR. Thoracoscopic repair of recurrent diaphragmatic hernia four years after initial trauma, laparotomy and repair. J Laparoendosc Adv Surg Tech 1999;9:171-175.
11. Hüttl T, Lang R, Meyer G. Long-term results after laparoscopic repair of traumatic diaphragmatic hernias. J Trauma 2002;52:562-566.
12. Haciibrahimoglu G, Solak O, Olcmen A, Bedirhan MA, Solmazer N, Gurses A. Management of traumatic diaphragmatic rupture. Surg Today 2004;34:111-114.
13. Antequera A, Diez J, García E, et al. Hernia: morbidity and mortality associated with traumatic diaphragmatic hernia. Br J Surg 1995;82:64.
14. Brasel KJ, Borgstrom DC, Meyer P, Weigelt JA. Predictors of outcome in blunt diaphragm rupture. J Trauma 1996;41:484-487.
15. Nursal TZ, Ugurlu M, Kologlu M, Hamaloglu E. Traumatic diaphragmatic hernias: a report of 26 cases. Hernia 2001;5:25-29.
16. Singh S, Kalan MM, Moreyra CE, Buckman RF. Diaphragmatic rupture presenting 50 years after the traumatic event. J Trauma 2000;49:156-159.
17. Iochum S, Ludig T, Walter F, Sebbag H, Grosdidier G, Blum AG. Imaging of diaphragmatic injury: a diagnostic challenge? RadioGraphics 2002;22:S103-118.
18. Leal-Mursuli A, Rodríguez-Varela R, Del Castillo-Puebla G, Bode-Sado A, Adefna-Pérez R. Hernia diafragmática traumática multivisceral: a propósito de un caso. Rev Cubana Cir 1999;38:99-101.
19. Leal-Mursuli A, Adefna-Pérez R, Ramos-Díaz N, Castellanos-González J, Larrinaga-Zayas JA, Rosas-Valladares C. Eventración diafragmática traumática derecha: reporte de un caso y revisión de la literatura. Rev Cubana Cir 2002;41:58-61.
20. Groneberg DA, Tai YF, Almari AF Pereira JH. Gastrointestinal: Diaphragmatic hernia. J Gastroenterol Hepatol 2001;16:1305.
21. Rodríguez-González HM, Schescke-Ruiz A. Ruptura diafragmática: un caso pasado por alto. Trauma 2003;6:28-33.
22. Meyers BF, McCabe CJ. Traumatic diaphragmatic hernia. Occult marker of serious injury. Ann Surg 1993;218:783-790.
23. Mehanna D, Young CJ, Solomon MJ. Large bowel obstruction due to diaphragmatic hernia. Aust NZ J Surg 1998;68:544-545.
24. Nari GA, Ponce O, Moll F, et al. Hernia diafragmática traumática crónica, presentación de tres casos. Acta Gastroenterol Latinoam 2003;33:205-209.
25. Alimoglu O, Eryilmaz R, Sahin M, Ozsoy MS. Delayed traumatic diaphragmatic hernias presenting with strangulation. Hernia 2004;8: 393-396.
26. Bergin D, Ennis R, Keogh C, Fenlon HM, Murray JG. The “dependent viscera” sign in CT diagnosis of blunt traumatic diaphragmatic rupture. AJR 2001;177:1137-1140.
27. Fibla JJ, Gómez G, Farina C, Penagos JC, Estrada G, Le Bergeron E, Clas D, Ratte S, et al. Impact of deferred treatment of blunt diaphragmatic rupture: A 15-year experience in six trauma centers in Quebec. J Trauma 2002;52:633-640.
28. Kulstad EB, Pisano MV, Shirakbari AA. Delayed presentation of traumatic diaphragmatic hernia. J Emerg Med 2003;24:455-457.
Full text