G S B Kishore1, V Gupta, R P Doley, A Kudari, N Kalra, T D Yadav, J D Wig. 1. Gastrointestinal Surgery Unit, Department of General Surgery, Postgraduate Institute of Medical Education and Research, 8H/5, Sector 12, PGI Campus, Chandigarh, 160012, India.
Abstract
BACKGROUND: Traumatic diaphragmatic hernia (TDH) resulting from traumatic diaphragmatic rupture (TDR) may not be easily detected and can lead to significant morbidity and mortality. PATIENTS AND METHODS: A retrospective case note analysis was performed of all patients treated for TDR at a major teaching hospital between March 2003 and March 2008. The aetiological factors, associated injuries, management and outcome were analysed. RESULTS: Twenty-seven patients were studied (24 males, 3 females) and their ages ranged from 16 to 72 years (median 35 years). TDR was left-sided in 85% and right-sided in 15%. Aetiology was blunt trauma in 81% and 19% had penetrating injury. Associated injuries were present in 81%. The most common approach for repair was transabdominal (89%); additional thoracotomy was needed in 11%. Herniation of abdominal contents was present in 85% and herniation of more than one organ was present in 57%. The diaphragmatic rent was repaired primarily in 89% using nonabsorbable sutures. Post-operative pulmonary complications occurred in 52% of patients. Three patients (11%) died. CONCLUSION: Left-sided blunt traumatic diaphragmatic rupture was more common than right-sided rupture. The most commonly herniated organs were the stomach and colon. Most ruptures could be repaired by an abdominal approach, which also allowed a complete exploration of the abdominal organs. Careful attention should be given to associated intra-abdominal injuries. Most of the defects were repaired directly using nonabsorbable sutures.
BACKGROUND:Traumatic diaphragmatic hernia (TDH) resulting from traumatic diaphragmatic rupture (TDR) may not be easily detected and can lead to significant morbidity and mortality. PATIENTS AND METHODS: A retrospective case note analysis was performed of all patients treated for TDR at a major teaching hospital between March 2003 and March 2008. The aetiological factors, associated injuries, management and outcome were analysed. RESULTS: Twenty-seven patients were studied (24 males, 3 females) and their ages ranged from 16 to 72 years (median 35 years). TDR was left-sided in 85% and right-sided in 15%. Aetiology was blunt trauma in 81% and 19% had penetrating injury. Associated injuries were present in 81%. The most common approach for repair was transabdominal (89%); additional thoracotomy was needed in 11%. Herniation of abdominal contents was present in 85% and herniation of more than one organ was present in 57%. The diaphragmatic rent was repaired primarily in 89% using nonabsorbable sutures. Post-operative pulmonary complications occurred in 52% of patients. Three patients (11%) died. CONCLUSION: Left-sided blunt traumatic diaphragmatic rupture was more common than right-sided rupture. The most commonly herniated organs were the stomach and colon. Most ruptures could be repaired by an abdominal approach, which also allowed a complete exploration of the abdominal organs. Careful attention should be given to associated intra-abdominal injuries. Most of the defects were repaired directly using nonabsorbable sutures.
Authors: Mohamad Khreiss; Joseph Karam; Khaled M Musallam; Ayman B Al Harakeh; Vivian G Nasr; George S Abi Saad Journal: Ann Thorac Surg Date: 2009-08 Impact factor: 4.330
Authors: Benjamin S Powell; Louis J Magnotti; Thomas J Schroeppel; Christopher W Finnell; Stephanie A Savage; Peter E Fischer; Timothy C Fabian; Martin A Croce Journal: Injury Date: 2008-03-11 Impact factor: 2.586
Authors: German Mínguez Ruiz; Luis J García Florez; R Dario Arias Pacheco; Isabel García Bear; Virginia Ramos Pérez; Gerardo Pire Abaitua Journal: J Surg Case Rep Date: 2018-08-20