The frequency with which either of these mechanisms lead to diaphragmatic injury varies according to the geographic location 1. Rightsided diaphragmatic rupture in a poly traumatized patient. Acute traumatic rupture of the diaphragm may go unnoticed and there is often a delay between the injury and the diagnosis. The incidence of posttraumatic blunt diaphragmatic injury varies from 0. Diaphragmatic rupture serves as a marker of serious multisystem trauma, but does not contribute signif icantly to mortality unless it goes unrecognized as the cause of severe cardiorespiratory embarrassment or delayed intestinal obstruction,lo in large series,6,7,9 the mortality rate has ranged from 22% to 36% and is due almost. Ultrasound diagnosis of diaphragmatic rupture springerlink. During 3 years period, a total of 245 intraports were placed in cancer patients for chemotherapy. Multislice ct and magnetic resonance imaging in the preoperative evaluation of trauma. Spontaneous rupture of the diaphragm archives of disease. The ct image b reveals the ruptured left hemidiaphragm arrows with haemothorax and rib fractures. Here are links to possibly useful sources of information about diaphragmatic rupture. Left dr in 47yearold man after a road traffic accident. Diaphragmatic rupture may result from traumatic injury usually from thoracoabdominal trauma, with an incidence of 0. Diaphragmatic rupture following blunt trauma sciencedirect.
The incidence of ruptured uteri was calculated to be 0. The patient was taken to the operating room for exploration and found to have rupture of the left diaphragm, which was repaired without complications. Tuberculous spondylodiskitis with a musculocutaneous fistula. Diagnosis of diaphragmatic rupture is difficult, and delays could result in a catastrophic outcome. An analysis focusing on thoracoabdominal trauma showed. Trends, risk factors and pregnancy outcome in women with uterine rupture. A traumatic right diaphragmatic rupture is an uncommon condition, as it occurs in 0. Diaphragmatic injury is uncommon, representing less than 1 percent of all traumatic injuries.
Most commonly, acquired diaphragmatic tears result from physical trauma. Particularly multislice ct is a valuable tool for evaluating subdiaphragmatic area, and diaphragm rupture and or herniation associated with postraumatic diaphragm paralysis 10. Leftsided diaphragmatic injuries account for 6070% of cases. Jun 18, 2017 explaining the boundaries of diaphragm, crura of the diaphragm,medial and lateral arcuate ligaments. Imaging of diaphragmatic rupture after trauma sciencedirect. The possible mechanisms of this rare complication are explained. Diaphragmatic injury is an unusual life threatening complication of blunt trauma abdomen. We present a rare case of a large diaphragmatic rupture with transthoracic gastric and colon herniation that was successfully. Although it is rare and overshadowed by associated injuries, delayed diagnosis with accompanied strangulation of herniated viscera will result in higher morbidity and mortality. Diaphragmatic rupture occurs due to blunt or penetrating injury, having either an acute presentation as a part of multiorgan injury or delayed presentation as respiratory distress or gut obstruction. The incidence of post trauma blunt diaphragmatic injury.
Records of 31 patients who sustained a ruptured diaphragm from blunt trauma form the basis for this report. The rupture occurs due to increased intraabdominal pressure from forceful impact. The patients hospital stay was incidentfree, and a cesarean section was due to be performed at the 34th week of gestation to achieve optimal. Diaphragmatic rupture occurs in approximately 5% of patients who have experienced major blunt trauma,3 and 90% of the diaphragmatic ruptures are on the left side. Additionally, approximately 25% of cases have a concomitant chest wall defect. This case demonstrates the importance of considering the diagnosis in all. Management of diaphragmatic rupture from blunt trauma. Spontaneous hemoperitoneum because of a ruptured gist without. Most blunt traumatic diaphragm ruptures are an indication for early aggressive surgical intervention by way of thoracotomy, laparotomy, or both if. A case of blunt traumatic rupture of the left hemidiaphragm following a traffic accident was presented. Imaging of diaphragmatic rupture linkedin slideshare. In recent scrutiny of our patients, we noted rupture of the right diaphragm to be as frequent as. Diaphragmatic rupture also called diaphragmatic injury or tear is a tear of the diaphragm, the muscle across the bottom of the ribcage that plays a crucial role in respiration. Although diaphragmatic injury can be obvious eg, herniation of abdominal contents on chest radiograph, the injury may be subtle, and imaging studies can be.
Diaphragmatic injuries are estimated to occur in 0. Diaphragmatic rupture often results from blunt abdominal trauma, which is usually associated with motorvehicle accidents as in this case. Explaining the boundaries of diaphragm, crura of the diaphragm,medial and lateral arcuate ligaments. Shoulder tip pain and suprapubic pain may reflect uterine rupture and require further investigation. Diaphragmatic injury may occur due to both penetrating and blunt trauma. Delayed presentation of traumatic diaphragmatic rupture with. The patient went to have a successful diaphragmatic repair. Delayed presentation of hemidiaphragm rupture following chest trauma is not unusual and emphasizes the importance of evaluating the diaphragm carefully on initial trauma ct scans. Diaphragmatic rupture and its complications following. Diaphragmatic rupture is a rare pathology that reported in less than 0. Traumaemergency radiology 477 ct of blunt diaphrag matic. There were 23 leftsided ruptures, one bilateral rupture, and seven rightsided ruptures. Maternal morbidity and mortality has been a major world health organization concern over the years, especially in sub. Diaphragmatic rupture is a lifethreatening condition.
Totally implantable central venous access devices intraports are commonly used in cancer patients to administer chemotherapy or parenteral nutrition. Traumatic diaphragmatic rupture is a recognized consequence of high velocity blunt trauma to the abdomen usually a result of motor vehicle accident. The frequency with which either of these mechanisms leads to diaphragmatic injury varies according to the geographic location. Early second trimester uterine rupture with a viable fetus. Nontraumatic, spontaneous diaphragmatic rupture is a rare event whose pathophysiology is not known. It can be managed through laparotomy or thoracotomy and with minimal access surgery. Diaphragmatic rupture causes a loss of continuity in muscular and tendinous fibers of the membrane, with resultant communication between the thoracic and abdominal cavities 1. Spontaneous diaphragmatic rupture from strenuous activity coughing, exercise, vaginal delivery, and vomiting is a rare surgical emergency. Barium meal showed bowel loops in the left hemithorax, which prompted surgical intervention. Left kidney and intestinals coils were found to herniate through the diaphragmatic tear. Sensitivity for the detection of rightsided diaphragmatic rupture was 50%, and specificity was 100%. The most common cause of blunt diaphragmatic rupture is road traffic accidents 2. All structured data from the file and property namespaces is available under the creative commons cc0 license. Diaphragmatic rupture can result from blunt or penetrating trauma and occurs in about 5% of.
Diaphragmatic injury management in the emergency department. The cough is a complex physiologic response designed to protect airways from unwanted secretions and foreign materials. The association of gastric perforation along with diaphragmatic injury increases the mortality as well as morbidity manifold as compared to an isolated diaphragmatic injury. Sensitivity for the detection of rightsided diaphragmatic rupture was 50% and specificity was 100%.
The mechanism of injury is typically a motorvehicle collision. A leftsided rupture is more common, and the defect tends to be located peripherally. Left side diaphragmatic injury with herniation of stomach, colon, spleen, omentum and small intestine. The entity of diaphragmatic rupture posttrauma was first described by sennertus in 1541. Of the 11 cases of diaphragmatic rupture, diaphragmatic discontinuity was seen in eight, visceral herniation was seen in six, and the collar. Trial of labor after cesarean tolac pearls of exxcellence. Although initial ct scan was inconspicuous, a followup ct scan revealed. Rightsided diaphragmatic rupture after blunt trauma. Ruptured ectopic pregnancy was suspected, and emergency laparotomy was performed. Tracheal rupture is a rare complication whose diagnosis is often delayed. In contrast, our patient only presented with abdominal bloating without pain. The true incidence of traumatic diaphragmatic rupture is unknown. Acute traumatic diaphragmatic ruptures are uncommon and occur in about 0. Rupture of the diaphragm mostly occurs following major trauma.
Zukoski, md, and believe that it does seem to emphasize an important diagnosis rupture of the right diaphragm. Violent and paroxysmal coughs are associated with many complications. In two patients a rupture of the diaphragm was diagnosed. Traumatic diaphragmatic rupture is frequently encountered in the cat see chapter 45 and is associated with herniation of abdominal contents, often including the stomach, into the pleural cavity. Spontaneous diaphragmatic rupture sdr is a very rare surgical emergency. Persistence for vaginal delivery after cesarean was the most common cause of uterine. Helical ct of diaphragmatic rupture caused by blunt trauma. Apr 25, 2012 blunt diaphragmatic rupture is a rare event that may occur after traumatic injury. The manual diaphragm release technique improves diaphragmatic. Diaphragmatic rupture definition of diaphragmatic rupture. Diaphragm rupture an overview sciencedirect topics. Uterine rupture is one of the dangerous obstetric problems with high potential of causing maternal.
A free powerpoint ppt presentation displayed as a flash slide show on id. Cardiac valves illustration cardiac valves illustration drag here to reorder. Management involves repair of the diaphragmatic defect via transthoracic andor transabdominal approaches. Traumatic diaphragmatic rupture with transthoracic organ. It is challenging to find the diagnosis immediately and is illustrated by the incidence of 1266% initially missed diagnosis. The most common ct finding of diaphragmatic rupture was the collar sign, identified in 15 patients sensitivity, 63%. Diaphragmatic ruptures are usually associated with abdominal trauma however, it can occur in isolation. Traumatic diaphragmatic rupture is uncommon with leftsided injuries more frequently reported than the right due to the protective nature of the liver. Journal of medical case reports diaphragmatic rupture with right colon and small intestine herniation after blunt trauma. If uterine rupture suspected diagnosed, resuscitate woman while arranging urgent laparotomy. May 01, 2020 diaphragmatic injuries are relatively rare and result from either blunt trauma or penetrating trauma. Evaluation of diagnostic accuracy at a level 1 trauma centre.
Diagnosis and treatment are similar regardless of mechanism, although many management issues are specific to blunt trauma. Traumatic diaphragmatic rupture, a diagnostic dilemma in. Tuberculous spondylodiskitis with a musculocutaneous. Diaphragmatic rupture is a predictor of serious associated injuries which, unfortunately, is itself often occult.
A possible explanation for sdr might be a sudden increase of intraabdominal pressure due to intense coughing, physical exercise, vomiting, or delivery. Rarely, herniation of the stomach into the pleural cavity can result in the life. Drawing view from below shows the large central tendon, which is formed by the transverse septum. Traumatic diaphragmatic rupture with underlying lung. Complications following cardiopulmonary resuscitation cpr are rare and usually follows a vigorous cpr or in special cases like pregnancy are due to lack of knowledge and clinical practice of how to preform cpr in pregnancy. Spontaneous diaphragmatic rupture in hypermobile type. To the best of our knowledge, this is a very rare case. Full text spontaneous uterine rupture in the 35th week of gestation. Diaphragmatic rupture can result from blunt or penetrating trauma and occurs in about 5% of cases of severe blunt trauma to the trunk. Traumatic diaphragmatic rupture article pdf available in south african medical journal suidafrikaanse tydskrif vir geneeskunde 488. Determinants of uterine rupture among cases of adama. Leftsided hemidiaphragmatic injury predominates probably because of the protective effect of the liver on the right hemidiaphragm andor underdiagnosis of rightsided injuries. Clinicians must maintain a high index of suspicion to correctly diagnose and manage this pathology. Ppt diaphragmatic hernias powerpoint presentation free.
Surgical intervention needs to be planned carefully in multidisciplinary team. The diaphragm is usually injured in association with other thoracic and abdominal organs. Delayed presentation of traumatic diaphragmatic hernia. Splenic flexure of the colon with omentum is herniated. Halfacree, in feline soft tissue and general surgery, 2014. Laparoscopic management of traumatic ruptures of the diaphragm. The diagnosis can be difficult to make as the physical examination may be unremarkable, and imaging, that is, a conventional chest xray andor ct imaging, may initially fail to reveal the injury. Delayed presentation of traumatic diaphragmatic rupture. Traumatic injuries of the diaphragm remain an entity of difficult diagnosis despite having been recognised early in the history of surgery, especially when it comes to blunt trauma and injuries of the right diaphragm.
In this article, we will discuss a patient who sustained diaphragmatic rupture as a result of violent coughing. Traumatic diaphragmatic injury suny downstate medical. Diaphragmatic rupture often results from blunt abdominal trauma. Chest radiography a shows multiple rib fractures and pleural fluid. There is a large hematoma extending along the posterolateral aspect of the left chest wall.
The patient has remained free of clinical symptoms since 10 months after the surgery. Early diagnosis is a clinical challenge as findings from chest xrays can mimic haemo or pneumothorax 4, such as in this patient. Diaphragmatic rupture with right colon and small intestine. These injuries are most commonly accompanied by injuries to the stomach, colon, and spleen. May 01, 2020 traumatic diaphragmatic rupture tdr is uncommon, with the incidence ranging from 1% to 8% in blunt trauma patients. Due to its rarity and difficulty in diagnosing, delayed detection of diaphragmatic injuries can occur. In their sample of 28 patients, 10 with diaphragm injury, the finding was 100% sensitive for leftsided rupture and 83% sensitive for rightsided rupture. This patient went on to have a laparoscopic diaphragmatic repair. Feto group also had a significantly greater rate of premature rupture of membranes than control group with the odds ratio of 3. Anterior and lateral attachments inferior sternum, xiphoid process, lower six ribs, and costal cartilage. Aug 21, 2009 diaphragmatic rupture is a lifethreatening condition. Most patients present with abdominal pain at the onset of rupture 57. Viscus had herniated into the chest in 30 patients.
Gastric disorders associated with diaphragmatic rupture. Four of these cases two colon cancer and one each of pancreas and breast cancer had rupture of the. Bedside emergency ultrasonographic diagnosis of diaphragmatic. As a result of the relatively high frequency of highspeed accidents, diaphragmatic rupture is a diagnosis that is increasingly being established.
Trends, risk factors and pregnancy outcome in women with uterine. We report a case of delayed presentation of traumatic diaphragmatic hernia on the left side in a 44yearold male who presented two weeks after a minor blunt trauma. Eventration of the diaphragm is the condition where the muscle is permanently elevated, but retains its continuity and attachments to the costal margins. Rare case of diaphragmatic rupture following resuscitation. Congenital diaphragmatic hernia in newborns is due to failure of the embryonic diaphragm to fuse. On arrival to the emergency department she was alert and complaining of pain in her left chest and abdomen. We report the case of a patient with blunt trauma with right diaphragmatic rupture that required urgent surgical treatment for hepatothorax and iatrogenic severe liver injury. Minor forms of diaphragm eventration are asymptomatic. The manual diaphragm release technique improves diaphragmatic mobility, inspiratory capacity and exercise capacity in people with chronic obstructive pulmonary disease. Rupture of totally implantable central venous access devices. When a conservative approach to trauma management is taken, blunt diaphragmatic rupture bdr remains undiagnosed at initial presentation in 7%66% of cases. The leading cause of diaphragmatic rupture is penetrating abdominal trauma, including gunshot and stabrelated wounds. The rate of missed diaphragmatic rupture on chest radiographs ranges from 12% to 66% with the potential risk of a late visceral herniation through the diaphragmatic defect, 16. Not all of these, usually multitraumatized, patients are diagnosed as having diaphragmatic rupture immediately following the traumatic event rather, an appreciable number of these injuries are not detected until some time.
The incidence rates of traumatic diaphragm rupture is between 0. Files are available under licenses specified on their description page. Blunt diaphragmatic rupture is a rare event that may occur after traumatic injury. Diaphragmatic injuries are quite uncommon and often result from either blunt or penetrating trauma. Given that the most common mechanism is motor vehicle collisions, it is perhaps unsurprising that young men are most frequently affected. Sep 16, 2011 ultrasound diagnosis of diaphragmatic rupture a 34yearold female was the restrained passenger in a highspeed motor vehicle collision. On admission the patient complained of a dyspnoea, and the physical examination of the thorax revealed the absence of breathing sound on the left side.
A 66yearold male patient presented with recurrent coughing, dyspnoea, and intermittent fever. Pdf ct of blunt diaphragmatic rupture researchgate. Diaphragmatic injury may occur due to both penetrating and blunt traumas. One of this complication is diaphragmatic rupture with herniation of abdominal organs. This can result in significant morbidity and mortality. Computed tomography the introduction of helical ct and new array detector technology in the 1990s has improved the accuracy of ct in the diagnosis of injuries in. However, a double blow injury occurring simultaneously such as diaphragmatic hernia and gastric injury is a rare injury. Uterine rupture is one of the most severe complications in pregnancy. Diagnosis of traumatic diaphragmatic rupture is often delayed due to lack of pathognomonic symptoms and signs. Bdr occurs with approximately the same frequency and injury pattern in adults and children alike 20,35. Registered users can also download a pdf or listen to a podcast of this pearl.
1021 1452 117 582 712 218 634 622 470 1044 946 1336 483 657 119 802 1421 1108 473 1031 511 376 645 1328 34 296 296 1320 146 984 32 1155 829 735 1215 1489