Journal of Trauma and Injury

Incidental traumatic right diaphragmatic rupture: a missed case after trauma: Fatima Alharmoodi, Shadin Ghabra, Salem Alharthi; J Trauma Inj. 2023;36(1):56-59. Published online June 23, 2022; DOI: https://doi.org/10.20408/jti.2022.0008

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Abstract PDF: Traumatic diaphragmatic hernia is among the most uncommon conditions after severe trauma, and it is associated with high morbidity and mortality. The diagnosis is difficult and might be missed, but a multimodal investigation might help in terms of diagnostic yield. In this case report, we present a missed right diaphragmatic rupture 14 years after the trauma.; Summary

Traumatic abdominal wall hernia with hemoperitoneum caused by blunt injury: laparoscopic exploration with mini-laparotomy repair. A case report: Euisung Jeong, Hyunseok Jang, Younggoun Jo, Yunchul Park, Naa Lee, Jungchul Kim; J Trauma Inj. 2022;35(1):61-65. Published online December 23, 2021; DOI: https://doi.org/10.20408/jti.2021.0062

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Traumatic abdominal wall hernia is a very rare clinical entity. Herein, we report the case of a patient who was transferred from a local clinic to the emergency department because of left lower abdominal pain. Initially, an intra-abdominal hematoma was observed on computed tomography and no extravasation was noted. Conservative treatment was initiated, and the patient’s symptoms were slightly relieved. However, though abdominal pain was relieved during the hospital stay, bowel herniation was suspected in the left periumbilical area. Follow-up computed tomography showed traumatic abdominal wall hernia with hemoperitoneum in the abdomen. We performed a laparoscopic exploration of the injury site and hernia lesion. The anterior abdominal wall hernia was successfully closed.

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Unique laparoscopic emergency management of traumatic obstructed abdominal wall hernia: A case report and review of literature
Arwa M Aljuhani, Ghaith A Al Saied, Arjmand Reyaz, Mohammed A Alkahlan, Ibrahim M Aljohani, Muhammed M Abukhater
International Journal of Abdominal Wall and Hernia.2024;[Epub] CrossRef

Comparison of Penetrating and Blunt Traumatic Diaphragmatic Injuries: Sang Su Lee, Sung Youl Hyun, Hyuk Jun Yang, Yong Su Lim, Jin Seong Cho, Jae Hyug Woo; J Trauma Inj. 2019;32(4):210-219. Published online December 30, 2019; DOI: https://doi.org/10.20408/jti.2019.034

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Abstract PDF

Purpose

Traumatic diaphragmatic injury (TDI) is no longer considered to be a rare condition in Korea. This study investigated differences in the prevalence of accompanying injuries and the prognosis in patients with traumatic diaphragmatic damage according to the mechanism of injury.

Methods

We retrospectively reviewed the medical records of patients with TDI who were seen at a regional emergency medical center from January 2000 to December 2018. Among severe trauma patients with traumatic diaphragmatic damage, adults older than 18 years of age with a known mechanism of injury were included in this study. Surgery performed within 6 hours after the injury was sustained was defined as emergency surgery. We assessed the survival rate and likelihood of respiratory compromise according to the mechanism of injury.

Results

In total, 103 patients were analyzed. The patients were categorized according to whether they had experienced a penetrating injury or a blunt injury. Thirty-five patients had sustained a penetrating injury, and traffic accidents were the most common cause of blunt injuries. The location of the injury did not show a statistically significant difference between these groups. Severity of TDI was more common in the blunt injury group than in the penetrating injury group, and was also more likely in patients with respiratory compromise. However, sex, the extent of damage, and the initial Glasgow coma scale score had no significant relationship with severity.

Conclusions

Based on the findings of this study, TDI should be recognized and managed proactively in patients with blunt injury and/or respiratory compromise. Early recognition and implementation of an appropriate management strategy would improve patients’ prognosis. Multi-center, prospective studies are needed in the future.

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An audit of traumatic haemothoraces in a regional hospital in KwaZulu-Natal, South Africa
CM Kithuka, VC Ntola, W Sibanda
South African Journal of Surgery.2023; 61(3): 12. CrossRef
Factors Associated with Successful Video-Assisted Thoracoscopic Surgery and Thoracotomy in the Management of Traumatic Hemothorax
Heather M. Grant, Alexander Knee, Michael V. Tirabassi
Journal of Surgical Research.2022; 269: 83. CrossRef

Laparoscopy in Blunt Abdominal Trauma: Diaphragmatic and Bladder Lacerations Repair: Ruben Martins, Martins dos Santos, Tatiana Revez; J Trauma Inj. 2019;32(3):176-180. Published online September 30, 2019; DOI: https://doi.org/10.20408/jti.2019.019

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Abstract PDF: The growing use of laparoscopy in elective surgery has led to its increase utilization in emergency surgery. However, the employment of laparoscopy in abdominal trauma is still unusual. Here in we report a case of a patient with blunt abdominal trauma that resulted in a combination of exceptional traumatic lesions, diaphragmatic and bladder lacerations. Both injuries were diagnosed and successfully resolved by laparoscopy. The report of this type of lesions and resolution is extremely rare, being this the second case described in the international literature. This article intends to show that laparoscopy may not only be used as a diagnostic tool, but also as a therapeutic instrument in selected cases of blunt abdominal trauma.; Summary

The Successful Removal of a Foreign Body in the Spleen via Diaphragm Laceration Site by Video-Assisted Thoracoscopic Surgery: Yang Bin Jeon, Sung Youl Hyun, Dae Sung Ma; J Trauma Inj. 2019;32(2):122-125. Published online June 30, 2019; DOI: https://doi.org/10.20408/jti.2018.055

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A 73-year-old man, who, in an inebriated state, had slipped in a flowerbed and was wounded on the left flank, was transferred to Trauma Center, Gil Medical Center, Gachon University College of Medicine. Based on the chest and abdominopelvic computed tomography, he was diagnosed with multiple rib fractures and hemopneumothorax on the left hemithorax and was found to have a bony fragment in the spleen. He had not presented peritonitis and exsanguinous symptoms during the observation period. Seven days later, computed tomography of the abdomen showed suspected diaphragmatic injury and a retained foreign body in the spleen. On exploration by video assisted thoracoc surgery (VATS), a herniated omentum through the lacerated site of the diaphragm was observed. After omentectomy using Endo Gia, the foreign body in the spleen was observed through the lacerated site of the diaphragm. Traumatic diaphragm rupture with a foreign body, in the spleen, was successfully managed by video assisted thoracic surgery via the lacerated site of the diaphragm.

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The role of VATS in the removal of intrathoracic foreign bodies — a systematic review
Fahmi Hussein Kakamad, Razhan Kawa Ali, Bnar Jamal Hama Amin, Shvan Hussein Mohammed, Diyar Adnan Omar, Karukh Khalid Mohammed, Sanaa Othman Karim, Suhaib Hussein Kakamad, Rawezh Qadir Mohammed Salih, Diyar Abubaker Mohammed, Abdulwahid Mohammed Salih, Mo
Indian Journal of Thoracic and Cardiovascular Surg.2023; 39(2): 125. CrossRef

Acute Pancreatitis after Additional Trauma in Chronic Traumatic Pancreatic Diaphragmatic Hernia: You Ho Mun, Sin Youl Park; J Trauma Inj. 2019;32(1):66-70. Published online March 31, 2019; DOI: https://doi.org/10.20408/jti.2019.007

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Abstract PDF: Traumatic diaphragmatic injuries (TDIs) are a rare complication in thoraco-abdominal trauma. The diagnosis is difficult and if left untreated, TDI can cause traumatic diaphragmatic hernia (TDH). Through an injured diaphragm, the liver, spleen, stomach, small intestine, and large intestine can be herniated to the thoracic cavity, but pancreatic herniation and pancreatitis are quite rare in TDH. This paper reports a case of pancreatitis developed by additional trauma in a patient with asymptomatic chronic TDH. A 58-year-old male visited the emergency department with a left abdominal injury after a fall 6 hours earlier. The vital signs were stable, but the amylase and lipase levels were elevated to 558 U/L and 1,664 U/L, respectively. Abdominal computed tomography (CT) revealed a left diaphragmatic hernia and an incarceration of the stomach, pancreatic ductal dilatation, and peripancreatic fatty infiltration. Additional history taking showed that he had suffered a fall approximately 20 years ago and had an accidentally diaphragmatic hernia through a chest CT 6 months earlier. A comparison with the previous CT revealed the pancreatitis to be caused by secondary pancreatic ductal obstruction due to the incarcerated stomach. For pancreatitis, gastrointestinal decompression was performed, and after 3 days, the pancreatic enzyme was normalized; hence, a thoracotomy was performed. A small ruptured diaphragm was found and reposition of the organs was performed. This paper reports the experience of successfully treating pancreatitis and pancreatic hernia developed after trauma without complications through a thoracotomy following gastrointestinal decompression.; Summary

Traumatic Bilateral Diaphragmatic Ruptures in a 6-Year-Old Boy: Sung Jin Kim, Hyuck Kim, Jun Ho Lee; J Trauma Inj. 2018;31(1):19-23. Published online April 30, 2018; DOI: https://doi.org/10.20408/jti.2018.31.1.19

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Abstract PDF: Traumatic diaphragmatic rupture is an unusual finding that may occur after blunt trauma. In addition, diaphragmatic rupture occurring bilaterally is extremely rare. We experienced a 6-year-old boy with bilateral diaphragmatic rupture, whom survived after surgical treatment by open thoracotomy but, complicated with spinal cord injury discovered after surgery.; Summary

Missed Traumatic Rupture of the Diaphragm: Sang Woo Ryu, Jaykey Chekar, In Ho Yi, Bo Ra Seo, Seong Huek Park, Seong Ju Go; J Trauma Inj. 2017;30(1):16-20. Published online March 31, 2017; DOI: https://doi.org/10.20408/jti.2017.30.1.16

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A 48-year-old man came to the emergency department with altered consciousness and hemoperitoneum following a pedestrian traffic accident. He underwent immediate emergency laparotomy, and on the second day, he required craniectomy because of increase of intracranial hemorrhage. A chest radiograph taken 7 days after admission, showed elevation of the right hemi-diaphragm, and follow-up chest CT showed a right-sided rupture of the diaphragm, which was surgically repaired. Rupture of the diaphragm can be easily overlooked and the diagnosis delayed, especially in unstable patients with multiple trauma or altered level of consciousness, as in the case reported here.

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Identification of Delayed Traumatic Diaphragmatic Injury: A Concise Review
Patricia J. Bartzak
Journal of Trauma Nursing.2022; 29(1): 47. CrossRef

Intraoperative Diagnosis of a Pericardial Injury Associated with Multiple Diaphragmatic Ruptures in a Patient with Abdominal Blunt Trauma: Do Wan Kim, In Seok Jeong, Kook Joo Na, Sang Yun Song, Kyo Seon Lee, Seung Ku Kang; J Trauma Inj. 2016;29(4):180-183. Published online December 31, 2016; DOI: https://doi.org/10.20408/jti.2016.29.4.180

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Abstract PDF: A diaphragmatic injury is uncommon, but occurs more frequently with injury to other organs. Particularly, a diaphragmatic accompanied by a pericardial injury is very rare. The authors report a case of incidentally detecting a pericardial injury during surgery for a diaphragmatic injury due to abdominal blunt trauma.; Summary

Right Diaphragmatic Injury Accompanied by Herniation of the Liver: A Case Report: Min A Lee, Kang Kook Choi, Gil Jae Lee, Byung Chul Yu, Dae Sung Ma, Yang Bin Jeon, Jung Nam Lee, Min Chung; J Trauma Inj. 2016;29(2):43-46. Published online June 30, 2016; DOI: https://doi.org/10.20408/jti.2016.29.2.43

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Abstract PDF: Traumatic diaphragmatic injury (TDI) occurs in 1% of patients of blunt abdominal trauma. Most TDIs involve the left diaphragm, however the authors experienced TDI accompanied by a liver laceration of the right diaphragm. When detected early, TDI can be easily treated, however serious complications can occur if not. When diaphragmatic injury is suspected due to clinical manifestation, comprehensive analysis of the patient data including radiologic findings is important.; Summary

Delayed Diaphragmatic Injury with Massive Hemothorax Due to Lower Rib Fracture: Woo Shik Kim, Joong Suck Kim; J Trauma Inj. 2015;28(2):79-82. Published online June 30, 2015; DOI: https://doi.org/10.20408/jti.2015.28.2.79

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Simple rib fracture is one of most common injury after blunt thoracic trauma found in approximately 7% to 40% of cases. Delayed traumatic diaphragmatic injury with massive hemothorax after rib fracture is rare but a potentially life-threatening condition. We present a rare case of a 79-year-old male with delayed diaphragmatic injury with massive hemothorax due to fracture of the lower ribs. Under thoracoscopy, hemothorax was evacuated, diaphragmatic rupture was identified and repaired, and the lower ribs were fixed with metal plate (s). Although simple lower rib fractures may be the only clinical finding, close observation and monitoring are required because of the possibility of diaphragmatic and/or intraabdominal organ injury.

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Fatal Delayed Hemothorax after Simple Rib Fracture
Minju Lee, Sang Bum Lim, Hye Jeong Kim, Sohyung Park, Hongil Ha
Korean Journal of Legal Medicine.2017; 41(2): 56. CrossRef

A Case of Tension Viscerothorax: A Rare Complication of Diaphragmatic Rupture after Blunt Abdominal Trauma: Maeng Real Park, Jae Ho Lee, Ji Yoon Ahn, Bum Jin Oh, Won Kim, Kyoung Soo Lim; J Korean Soc Traumatol. 2006;19(2):201-205.

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Abstract PDF: Tension viscerothorax (gastrothorax) is rare life-threatening disease which is caused by air trapped in viscera. A distended viscera in the hemi-thorax shifts the mediastinal structures and causes extra-cardiac obstructive shock. A defective diaphragm is caused by abdominal trauma or a congenital anomaly. Traumatic diaphragmatic injury can be missed until herniation develops several years after blunt trauma. In our case, a 10-year old boy developed hemodynamic compromise in the emergency department. Three years earlier, he had suffered blunt abdominal trauma during a pedestrian traffic accident, but there was no evidence of diaphragmatic injury at that time. He was successfully resuscitated by gastric decompression and an emergent thoracic operation. The operation finding revealed a traumatic diaphragmatic injury. Tension viscerothorax is a rare, but catastrophic, condition, so we suggest that addition of tension viscerothorax to the Advanced Trauma and Life Support (ATLS) guidelines may be helpful.; Summary

Right Diaphragmatic Rupture after Blunt Trauma: Case Report: Ki Hoon Kim, Jin Su Kim, Sung Jin Park, Woon Won Kim, Do Kyun Kang, Ho Gi Min, Yong Han Kim, Cheol Gyu O; J Korean Soc Traumatol. 2012;25(3):87-90.

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Abstract PDF: Blunt diaphragmatic rupture (BDR) is a relatively rare injury and occurs in 0.8% to 7% of all thorocoabdominal blunt trauma. Especially right diaphragmatic rupture after blunt abdominal trauma is a rarer than left. The diagnosis of BDR can be missed while evaluating the multiple trauma patient. Other severe injuries may mask BDR during the primary resuscitation and survey. We experienced two cases of traumatic rupture of right diaphragm, one diagnosed immediately and the other diagnosed delayed. In this paper we present two cases of traumatic diaphragmatic rupture.; Summary

Hemothorax Without Injury of the Pleural Cavity due to Diaphragmatic and Liver Laceration Caused by a Right Upper Anterior Chest Stab Wound: Kyu Seok Cho, Hyo Chul Youn, Jung Heon Kim, Sang Mok Lee; J Korean Soc Traumatol. 2010;23(1):49-52.

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Abstract PDF: A hemothorax usually occur, due to injuries to the intercostal and great vessels, pulmonary damage, and sometimes fractured ribs. We report a case in which the hemothorax that occurred, neither intrathoracic injury nor injury to internal thoracic vessels and organs, via lacerated diaphragmatic and liver laceration due to a right upper part of anterior chest stab injury caused by a sharp object. The patient's general conditions gradually worsened, so chest and abdominal computed tomogram were taken. The abdominal computed tomogram revealed diaphragmatic injuries and bleeding from the lacerated liver. We performed an exploratory laparotomy to control the bleeding from the lacerated liver with simple primary sutures. In addition exploration was performed in the right pleural space through the lacerated diaphragm with a thoracoscopic instrument. There were no bleeding foci in the right pleural space, the vessels, or the lung on the thoracoscopic video. Closure of the lacerated diaphragm was achieved with simple, primary sutures. The postoperative course of the patient was uneventful, and the patient was discharged.; Summary

Management of Traumatic Diaphragmatic Rupture: Seon Hee Kim, Jeong Su Cho, Yeong Dae Kim, Ho Seok I, Seunghwan Song, Up Huh, Jae Hun Kim, Sung Jin Park; J Trauma Inj. 2012;25(4):217-222.

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Abstract PDF: PURPOSE
Diaphragmatic rupture following trauma is often an associated and missed injury. This report is about our experience with treating traumatic diaphragmatic rupture (TDR).
METHODS
From January 2007 to September 2012, 18 patients who had a diaphragmatic rupture due to blunt trauma or penetrating injury underwent an operation for diaphragmatic rupture at our hospital. We retrospectively reviewed their medical records, including demographic factors, initial vital signs, associated injuries, interval between trauma and diagnosis, injured side of the diaphragm, diagnostic tools, surgical method or approaches, operative time, herniated organs, complications, and mortality.
RESULTS
The average age of the patients was 43 years, and 16 patients were male. Causes of trauma included motor vehicle crashes (n=7), falls (n=7), and stab wounds (n=5). The TDR was right-sided in 6 patients and left-sided in 12. The diagnosis was made by using a chest X-ray (n=3), and thorax or upper abdominal computed tomography (n=15). Ten(10) patients were diagnosed within 12 hours. A thoracotomy was performed in 8 patients, a video-assisted thoracoscopic surgery in 4 patients, a laparotomy in 3 patients, and a sternotomy in one patient. Herniated organs were the omentum (n=11), stomach (n=8), spleen and colon (n=6), and liver (n=6). Eighteen diaphragmatic injuries were repaired primarily. Seven patients underwent ventilator care, and two of them had pneumonia and acute respiratory distress syndrome. There were no operative mortalities.
CONCLUSION
Early diagnosis and surgical treatment determine the successful management of TDR with or without the herniation of abdominal organs. The surgical approach to TDR is chosen based on accompanying organ injuries and the injured side.; Summary

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