Traumatic diaphragmatic hernia
| Traumatic diaphragmatic hernia | |
 | |
|---|---|
| An X-ray showing the spleen in the left lower portion of the chest cavity (X and arrow) after a diaphragmatic tear[1] | |
| ICD-9 | 862.0 |
| eMedicine | med/3487 |
| MeSH | D006549 |
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Overview
A traumatic diaphragmatic hernia is a type of diaphragmatic hernia which is acquired through an abdominal injury. This is in contrast to a congenital diaphragmatic hernia, which is present from birth.
Diaphragmatic injury accounts for 0.8-1.6% of blunt trauma abdomen. Approximately 4-6% of patients who undergo surgery for trauma have a diaphragmatic injury.[2]
Historical Perspective
Traumatic diaphragmatic hernia apparently was described by Sennertus, who in 1541 reported an instance of delayed herniation of viscera through an injured diaphragm.[3] Ambroise Paré, in 1579, described the first case of diaphragmatic rupture diagnosed at autopsy. The first successful diaphragmatic repair was reported by Riolfi in 1886 in a patient with omental prolapse, and Naumann in 1888 repaired the defect with herniated stomach.
Pathophysiology
Diaphragmatic injuries are caused either by penetrating or blunt injuries to the abdomen. They are diagnosed immediately as part of multi-organ injury, or present later either with respiratory distress or as intestinal obstruction.[4] The mechanism in blunt injury is explained by shearing of a stretched membrane, avulsion at the point of diaphragmatic attachment, and the sudden force transmission through viscera acting as viscous fluid. Left sided injuries are more often seen. Left-sided rupture occurred in 68.5% of the patients, 24.2% had right-sided rupture, 1.5% had bilateral rupture, 0.9% had pericardial rupture, and 4.9% were unclassified.[2] Increased strength of the right hemi-diaphragm, hepatic protection of the right side, under diagnosis of right-sided ruptures, and weakness of the left hemi-diaphragm at points of embryonic fusion all have been proposed to explain the predominance of left sided diaphragmatic injuries.[2] Autopsy studies reveals that the incidence of rupture is almost equal on both sides but the greater force needed for the right rupture. A positive pressure gradient of 7-20 cms of H2O between the intraperitoneal and the intra pleural cavities forces the contents into the thorax. With severe blunt trauma the pressures may rise to as high as 100cms of water.
It can occur after splenectomy.[5]
Because it can be indicative of severe trauma, it often co-presents with pelvic fracture.[6]
Diagnosis
Differential Diagnosis
Complications
Treatment
Prognosis
See also
References
- ↑ Hariharan D, Singhal R, Kinra S, Chilton A (2006). "Post traumatic intra thoracic spleen presenting with upper GI bleed! A case report". BMC Gastroenterol. 6: 38. doi:10.1186/1471-230X-6-38. PMC 1687187. PMID 17132174.
- ↑ 2.0 2.1 2.2 Ala-Kulju K, Verkkala K, Ketonen P, Harjola PT (1986). "Traumatic rupture of the right hemidiaphragm". Scand J Thorac Cardiovasc Surg. 20 (2): 109–14. PMID 3738439.
- ↑ Shah R, Sabanathan S, Mearns AJ, Choudhury AK (1995). "Traumatic rupture of diaphragm". Ann. Thorac. Surg. 60 (5): 1444–9. doi:10.1016/0003-4975(95)00629-Y. PMID 8526655. Unknown parameter
|month=ignored (help) - ↑ CARTER BN, GIUSEFFI J, FELSON B (1951). "Traumatic diaphragmatic hernia". Am J Roentgenol Radium Ther. 65 (1): 56–72. PMID 14799666. Unknown parameter
|month=ignored (help) - ↑ Tsuboi K, Omura N, Kashiwagi H, Kawasaki N, Suzuki Y, Yanaga K (2008). "Delayed traumatic diaphragmatic hernia after open splenectomy: report of a case". Surg. Today. 38 (4): 352–4. doi:10.1007/s00595-007-3627-0. PMID 18368327.
- ↑ Meyers BF, McCabe CJ (1993). "Traumatic diaphragmatic hernia. Occult marker of serious injury". Ann. Surg. 218 (6): 783–90. PMC 1243075. PMID 8257229. Unknown parameter
|month=ignored (help)
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