1/48. Bochdalek hernia in adulthood: a case report and review of recent literature.A 37-year-old Filipino woman presented with a post road-traffic accident fracture of dorsal spine 12. Chest radiograph revealed evidence of loops of small bowel in the left lung field. She admitted to symptoms of respiratory insufficiency since birth and treatment for tuberculosis in childhood. A pre-operative diagnosis of left traumatic diaphragmatic hernia was not confirmed at laparotomy which revealed typical left congenital Bochdalek hernia with smooth edges and herniation of small bowel and spleen into the left pleural cavity. Following reduction and repair of the hernia, the patient made an uneventful recovery. Chest radiograph remains normal till now, eight years post-operatively.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
2/48. Posttraumatic diaphragmatic hernia and death--etiologic factor or putrefactive artifact?Late-presenting diaphragmatic hernias, whether congenital or acquired, may remain clinically undetected until mediastinal shift with cardiorespiratory compromise or intestinal or gastric infarction with perforation occur. A right-sided diaphragmatic hernia with herniation of small intestine into the adjacent pleural cavity is described in a 72-year-old man who was found dead at home in a putrefactive state. Subsequently, a history of a motor vehicle accident 8 years previously was obtained. Although postmortem herniation due to extensive putrefactive change may have occurred, producing gaseous distention and migration of the intestine, tight twisting of the herniated intestine several times around a pleural fibrous adhesion suggested that the herniation could have been an antemortem event. Unfortunately, marked tissue autolysis prevented assessment of possible ischemic changes in the herniated intestine. Although diaphragmatic hernia may be a contributing factor to death at all ages, it may not be possible to exclude it as an artifact of putrefaction in a predisposed individual.- - - - - - - - - - ranking = 3keywords = herniation (Clic here for more details about this article) |
3/48. Diaphragmatic rupture with cardiac tamponade.Intrapericardial herniation of abdominal viscera following blunt abdominal trauma is rare. We have been able to find only nine reported cases. Six of these were finally diagnosed after a long delay, ranging from a year to 23 years. Three were diagnosed within three months of the original injury, but in these patients, the investigations were initiated following an abnormal chest skiagram. We wish to report a unique case in which a traumatic intrapericardial hernia presented as an acute cardiac tamponade within 48 hours of injury.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
4/48. The role of laparoscopy in the diagnosis and treatment of missed diaphragmatic rupture.BACKGROUND: Diaphragmatic rupture is one of the most commonly missed injuries in trauma cases. Traditionally, laparotomy or thoracotomy has been the treatment of choice for this condition. methods: During the last 2 years, we treated three patients laparoscopically to address neglected diaphragmatic ruptures that caused herniation of the intraabdominal contents. RESULTS: In all three cases, laparoscopy succeeded in identifying the diaphragmatic defect, so that the herniated viscera could be released and the defect repaired primarily or with a prosthesis. The intraoperative and the postoperative courses were uneventful; there were no significant complications. CONCLUSION: laparoscopy has an important role in the surgical treatment of missed diaphragmatic ruptures.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
5/48. Traumatic intrapericardial diaphragmatic hernia: case report and literature review.A traumatic rupture of the diaphragm, with herniation of the abdominal viscera into the thoracic cavity, is relatively rare, being observed in approximately 3-7% of all abdominal or thoracic traumas [1]. Herniation into the pericardium is very rare [2]. We have reviewed the post-traumatic intrapericardial diaphragmatic hernias (TIPDH) published in the world literature within our reach and, as it was already stated in the review carried out by Van Loenhout et al. [3] in 1986, approximately one post-traumatic intrapericardial hernia is reported every year. The patient that we present makes case 82 of those published until October of 1999.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
6/48. Thoracolaparoscopic repair of traumatic diaphragmatic rupture.Diaphragmatic rupture may occur after blunt or penetration trauma caused by the application of a powerful external force. Diaphragmatic rupture usually is repaired via laporotomy and/or thoracotomy, depending on the associated organ injury. The case of a 49-year-old man with traumatic rupture of the left hemidiaphragm is presented. Preoperatively, diaphragmatic rupture with herniation of the stomach into the left thoracic cavity was confirmed by computed tomography scan of the thorax. Under thoracoscopic guidance, the stomach, spleen, and omentum were repositioned in the abdominal cavity, and the rupture site (10 cm) was closed by nonabsorbable suture. A subsequent laparoscopy was performed to assess the efficacy of the repair and the absence of any abdominal organ injury. The patient was discharged from hospital without any respiratory or abdominal symptoms. Our report confirms that in the case of a patient with penetration injuries to the lower chest and upper abdomen, a combined thoracoscopic and laparoscopic approach may offer both diagnostic and therapeutic benefits with reduced surgical trauma. We conclude that thoracoscopic repair of traumatic diaphragmatic rupture can be used safely when no abdominal organ injuries are found.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
7/48. Traumatic diaphragmatic hernia presenting as a tension fecopneumothorax.Diaphragmatic injury with accompanying hernia is a well-documented complication associated with both penetrating and blunt trauma. It occurs in approximately 3% of abdominal injuries with a 2:1 ratio of penetrating to blunt trauma. diagnosis requires a high index of suspicion since diaphragmatic injury can only reliably be ruled out by direct visualization, i.e., laparoscopy. Hence, delayed presentation with complications secondary to the injury is not uncommon. We discuss a case of a young man who presented in respiratory distress six years after a stab wound to the left chest. The patient was hypoxic, with a chest X-ray (CXR) demonstrating a pneumothorax with effusion. A chest tube was placed with a rush of air and foul-smelling purulent drainage. work-up revealed incarcerated transverse colon in a diaphragmatic hernia. Celiotomy demonstrated necrotic colon in the chest with gross fecal contamination in both the chest and abdomen. The diaphragmatic defect was closed and a Hartmann's procedure performed. The patient did well postoperatively except for the development of an empyema, which resolved with conservative management. Our patient is the eleventh reported case of a tension fecopneumothorax resulting from traumatic diaphragmatic herniation. This paper reviews all cases including the diagnostic work-up, operative approach, and ex ected postoperative course of this unusual condition.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
8/48. Chronic traumatic and congenital diaphragmatic hernias: presentation and surgical management.BACKGROUND: The diagnosis of chronic diaphragmatic hernias, whether due to congenital defects or trauma, may be difficult to make and may rely on clinical suspicion in the setting of persistent nondiagnostic radiographic findings. Repair is indicated to avoid catastrophic cardiopulmonary compromise and/or incarceration of abdominal organs. STUDY OBJECTIVES: To review the varied presentations and treatment of chronic diaphragmatic hernia. DESIGN: Retrospective review. SETTING: University of washington and Harborview Medical Center, Seattle, washington. patients: Between 1997 and 2001, nine patients presented with chronic diaphragmatic hernia (two congenital cases, seven post-traumatic cases). Four cases involved the right diaphragm. The following clinical features were noted: asymptomatic, chest radiograph showing bowel herniation (n=1); chest wall mass (n=1); asymptomatic with the chest radiograph showing marked elevation of hemidiaphragm (n=1); dyspnea with the chest radiograph showing marked elevation of hemidiaphragm (n=1); diarrhea and heartburn (n=1); generalized gastrointestinal upset (n=1); recurrent pneumonia (n=2); recurring effusions (n=4); and dyspnea on exertion (n=5). INTERVENTIONS: diagnosis was confirmed by chest radiograph in two patients, chest computed tomography scan in one patient, barium studies in three patients and thoracoscopy in three patients. All hernias were repaired via thoracotomy, and two hernias were repaired with artificial patch. CONCLUSIONS: patients with chronic diaphragmatic hernias present with a variety of symptoms and radiographic findings. When radiology or symptoms suggest bowel involvement, barium studies are appropriate. In other cases, chest computed tomography scans and/or thoracoscopy are useful. Repair is accomplished through the ipsilateral chest, with primary repair of the diaphragm preferred over patch repair.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
9/48. The role of MRI in traumatic rupture of the diaphragm. Our experience in three cases and review of the literature.PURPOSE: To evaluate the role and effectiveness of magnetic resonance imaging (MRI) in blunt diaphragmatic injuries by reviewing the literature and our experience in three cases. MATERIALS AND methods: We reviewed the medical records and MRI findings of three patients with diaphragmatic injury due to blunt abdominal trauma. All patients were previously examined with chest X-ray and CT and later with MRI at our institution. Coronal and sagittal SE TI-w and fast SE T2-w sequence images were acquired. All patients underwent surgery. RESULTS: MRI showed a 5.5 cm tear in the left hemidiaphragmatic dome with herniation of the stomach and colon into the thoracic cavity in the first case; a 1 cm tear in the diaphragmatic dome with herniation of the stomach and posterior abscess in the second case; and an 8 cm breach in the left diaphragm with visceral herniation in the third case. CONCLUSIONS: The major advantage of MRI lies in its capability of directly acquiring coronal and sagittal images allowing evaluation of the entire diaphragm, both in normal and in pathological conditions. In our experience, MRI showed the exact site and size of the diaphragmatic rupture in all cases. However, this technique cannot be performed in emergency situations or in multitrauma patients. Therefore, in agreement with the literature, helical CT remains the modality of choice in traumatic patients. MR imaging is useful only in doubtful cases and in haemodynamically stable patients.- - - - - - - - - - ranking = 3keywords = herniation (Clic here for more details about this article) |
10/48. Traumatic diaphragmatic rupture: can oral contrast increase CT detectability?Traumatic diaphragmatic rupture is a frequently missed diagnosis. We present a patient with traumatic diaphragmatic hernia. diagnosis was suggested by a emergent computed tomography (CT) examination without oral contrast. Diaphragmatic rupture and herniation of stomach were confirmed by repeating CT examination after the administration of oral contrast and using multiplanar reconstruction.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
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