RESUMEN
Traumatic diaphragmatic hernia is a rare condition that occurs after trauma, and some patients have a delayed presentation. A laparoscopic approach is rarely used to repair traumatic diaphragmatic hernias. We encountered a case of asymptomatic diaphragmatic hernia diagnosed after a comprehensive medical examination. A 71-year-old woman was diagnosed with a delayed presentation of traumatic diaphragmatic hernia with prolapse of the greater omentum owing to a traffic injury 20 years ago. Surgery was performed laparoscopically using three ports, and intraoperative respiratory management was performed using a double-lumen tube. The 2.5-cm-diameter hernial orifice was sutured under contralateral one-lung ventilation after the greater omentum was returned to the abdominal cavity. The patient's postoperative course was uneventful, and she was discharged on the third day. Intraoperative strategies such as respiratory management and the laparoscopic approach play a crucial role in ensuring favorable postoperative outcomes. The last follow-up was at six months post-operation, and the patient was doing well.
RESUMEN
Introduction Traumatic diaphragmatic injuries (TDIs) are uncommon and the incidence of TDI is difficult to estimate because of the variation in reporting missed or late detected diaphragmatic injuries. Therefore, our study's aim was to investigate the prevalence of traumatic diaphragmatic injury in the thoracoabdominal trauma, discuss the etiological factors, diagnostic investigations, and outcomes in TDIs, and evaluate predictors of mortality in patients who were diagnosed at King Abdulaziz Medical City in Riyadh, Saudi Arabia. Materials and methods This observational retrospective cohort study was conducted at King Abdulaziz Medical City (KAMC), a tertiary hospital in Riyadh, Saudi Arabia. The study included all adult patients aged 18 years or older diagnosed with traumatic diaphragmatic injuries between the years 2016 and 2020. The BESTCare electronic system was used to get the patient's medical records and extract the data. Pearson χ2 test was used for categorical variables, and an independent t-test was used for continuous variables to investigate the association between predictors and outcomes. Results A total of eight patients were involved in this study. The mean age of the patients was 49 years old. Males outnumbered females by 75%. Patients admitted with blunt injuries were greater by 75% compared to penetrating injuries by 25%. The left side of the diaphragm was the most common site of injury. The total number of patients who were admitted to the ICU was five, four of whom had blunt trauma and one had a penetrating injury. Conclusion The demographic data of the patients included in this study corresponded to that in the literature. Although not reaching a statistically significant level, ICU admissions and mortality were mostly associated with blunt injuries. Larger multi-center studies are required to further investigate the incidence of traumatic diaphragmatic injuries (TDI).
RESUMEN
Traumatic diaphragmatic hernia (TDH) is a rare condition resulting from blunt or penetrating thoracoabdominal trauma and is characterized by the protrusion of abdominal organs into the thoracic cavity through a ruptured diaphragm. Due to its diverse clinical presentations, TDH often faces diagnostic challenges. Accurate diagnosis relies on imaging studies and surgical exploration, with surgical intervention being the primary treatment approach. This case presentation highlights a young patient who presented to Saint George Hospital following a blunt thoracoabdominal injury. The patient experienced unexplained dyspnea upon admission, and imaging revealed herniated bowels in the left hemithorax. Laparoscopic exploration confirmed a left hemi-diaphragmatic tear, with the transverse colon, omentum, most of the small bowel, and stomach herniating into the left hemithorax. The patient underwent laparoscopic repair, involving the reduction of the herniated organs into the peritoneal cavity and tension-free primary closure with gastropexy without the use of mesh for reinforcement. The patient's postoperative course was uneventful, and complete recovery was achieved. This case report provides insights into the diagnosis and management of TDH, highlighting the importance of prompt recognition and appropriate surgical intervention in achieving successful outcomes.
RESUMEN
We present a rare case of incarcerated traumatic diaphragmatic hernia (TDH) at the right-side presenting as dramatic dyspnea and acute gastrointestinal obstruction, which required urgent operative repair. This entity is sometimes difficult to ascertain after acute trauma and then consequently give rise to diagnostic delays with life-threatening outcomes. Successful management required a coordinated effort between anesthetist, sonographer, intensive care specialist, thoracic, urological, hepatobiliary and gastrointestinal surgeons. Tight and active multidisciplinary cooperation in this case manifested the positive energy in emergent resuscitation.