BACKGROUND: Traumatic diaphragmatic rupture remains a diagnostic challenge often unrecognized until laparotomy in over 40% of patients and the diagnosis is delayed in a further 15%. This report describes four patients diagnosed at laparoscopy with a ruptured diaphragm. METHODS: One patient had a left diaphragmatic rupture amenable to laparoscopic repair in the emergency setting. Three patients underwent laparoscopy 2, 7 and 10 days after injury which revealed two right-sided and one extensive left-sided rupture, respectively; each required open repair. RESULTS: While laparoscopy is an excellent diagnostic tool, particularly in the delayed setting, repair is not possible for right-sided ruptures because of the liver bulk. CONCLUSIONS: Thoracoscopy in the instance of delayed presentation may offer the best chance for minimal-access diagnosis and treatment when there is suspicion of a right-sided diaphragmatic rupture.
BACKGROUND:Traumatic diaphragmatic rupture remains a diagnostic challenge often unrecognized until laparotomy in over 40% of patients and the diagnosis is delayed in a further 15%. This report describes four patients diagnosed at laparoscopy with a ruptured diaphragm. METHODS: One patient had a left diaphragmatic rupture amenable to laparoscopic repair in the emergency setting. Three patients underwent laparoscopy 2, 7 and 10 days after injury which revealed two right-sided and one extensive left-sided rupture, respectively; each required open repair. RESULTS: While laparoscopy is an excellent diagnostic tool, particularly in the delayed setting, repair is not possible for right-sided ruptures because of the liver bulk. CONCLUSIONS: Thoracoscopy in the instance of delayed presentation may offer the best chance for minimal-access diagnosis and treatment when there is suspicion of a right-sided diaphragmatic rupture.
Authors: George Pei Cheung Yang; Chung Ngai Tang; Wing Tai Siu; Joe Ping Yiu Ha; Yuk Ping Tai; Michael KaWah Li Journal: JSLS Date: 2005 Jul-Sep Impact factor: 2.172
Authors: Sandesh V Parelkar; Sanjay N Oak; Jiwan L Patel; Beejal V Sanghvi; Prashant B Joshi; Subrat K Sahoo; Nandita Sampat Journal: J Indian Assoc Pediatr Surg Date: 2012-10