Ann Surg Treat Res.  2018 Jun;94(6):342-345. 10.4174/astr.2018.94.6.342.

Right-sided diaphragmatic rupture in a poly traumatized patient

• Lee JY
• Sul YH
• Ye JB
• Ko SJ
• Choi JH
• Kim JS

• KMID: 2412405
• DOI: http://doi.org/10.4174/astr.2018.94.6.342

Abstract

Traumatic diaphragmatic rupture (TDR) is uncommon, and may be associated with other severe life-threatening injuries after blunt trauma. Recently, we experienced a right-sided TDR patient with other multiple life-threatening injuries. A 59-year-old female inflicted with a right-sided TDR accompanied by herniated liver was treated with thoracoscopic exploration. We successfully managed associated life-threatening injuries such as traumatic brain injury and pelvic bone fractures with bleeding, simultaneously.

Keyword

Trauma; Diaphragm; Rupture; Liver; Thoracoscope

MeSH Terms

Brain Injuries
Diaphragm
Female
Hemorrhage
Humans
Liver
Middle Aged
Pelvic Bones
Rupture*
Thoracoscopes

Figure

• 

  Fig. 1 Initial chest radiologic findings show elevated right diaphragm (white arrows).

• 

  Fig. 2 (A) Abdomen and pelvic CT (APCT) shows an area of hypoattenuation in the dome of the liver (arrows). (B) APCT shows herniation of liver dome through a diaphragmatic rupture (white arrow, hump sign), waistlike constriction of liver (arrowhead, collar sign), and linear area of subtle hypoattenuation (black arrows, band sign).

• 

  Fig. 3 (A) Operative findings show diaphragmatic rupture with herniation of liver. (B) Operative findings show diaphragmatic repair done by interrupted pledgeted sutures.

• 

  Fig. 4 (A) Pre-embolization angiographic finding showing extravasation (black arrow). (B) Postembolization angiographic finding showing no extravasation.

Reference

1. Hanna WC, Ferri LE. Acute traumatic diaphragmatic injury. Thorac Surg Clin. 2009; 19:485–489. PMID: 20112631.

2. Scharff JR, Naunheim KS. Traumatic diaphragmatic injuries. Thorac Surg Clin. 2007; 17:81–85. PMID: 17650700.

3. Kearney PA, Rouhana SW, Burney RE. Blunt rupture of the diaphragm: mechanism, diagnosis, and treatment. Ann Emerg Med. 1989; 18:1326–1330. PMID: 2589701.

4. Thiam O, Konate I, Gueye ML, Toure AO, Seck M, Cisse M, et al. Traumatic diaphragmatic injuries: epidemiological, diagnostic and therapeutic aspects. Springerplus. 2016; 5:1614. PMID: 27652187.

5. Vermillion JM, Wilson EB, Smith RW. Traumatic diaphragmatic hernia presenting as a tension fecopneumothorax. Hernia. 2001; 5:158–160. PMID: 11759804.

6. Andrus CH, Morton JH. Rupture of the diaphragm after blunt trauma. Am J Surg. 1970; 119:686–693. PMID: 5445992.

7. Eren S, Ciris F. Diaphragmatic hernia: diagnostic approaches with review of the literature. Eur J Radiol. 2005; 54:448–459. PMID: 15899350.

8. Rodriguez-Morales G, Rodriguez A, Shatney CH. Acute rupture of the diaphragm in blunt trauma: analysis of 60 patients. J Trauma. 1986; 26:438–444. PMID: 3701892.

9. Dwivedi S, Banode P, Gharde P, Bhatt M, Ratanlal Johrapurkar S. Treating traumatic injuries of the diaphragm. J Emerg Trauma Shock. 2010; 3:173–176. PMID: 20606795.

10. Ties JS, Peschman JR, Moreno A, Mathiason MA, Kallies KJ, Martin RF, et al. Evolution in the management of traumatic diaphragmatic injuries: a multicenter review. J Trauma Acute Care Surg. 2014; 76:1024–1028. PMID: 24662867.