Acquired diaphragmatic hernia in a preterm low birth weight neonate.

Iatrogenic diaphragmatic hernia is rare in children and we report a preterm low birth weight neonate with a presumably acquired diaphragmatic hernia due to trauma caused by treatment following pneumothorax.

Tension viscerothorax after blunt abdominal trauma: a case report and review of the literature.

BACKGROUND: Tension viscerothorax is herniation of abdominal viscera into the thorax. Tension viscerothorax can simulate tension pneumothorax. Immediate decompression with a nasogastric tube is required for hemodynamic stabilization. OBJECTIVE: A case of tension viscerothorax is reported along with a review of the literature to highlight this rare complication of blunt abdominal trauma, and to emphasize the importance of nasogastric tube decompression in tension viscerothorax. CASE REPORT: A 10-year-old boy with a remote history of trauma related to a motor vehicle crash was brought into the Emergency Department with a 3-day history of vomiting, epigastric pain, and dyspnea. By physical examination and chest X-ray study, tension gastrothorax was diagnosed. Nasogastric tube placement was difficult and delayed, and the patient deteriorated into cardiac arrest, but after successful cardiopulmonary resuscitation and nasogastric tube insertion, the patient was stabilized. Laparotomy was performed and primary repair of a ruptured diaphragm was done. The patient made an uneventful recovery. CONCLUSION: Acute tension viscerothorax should be considered in the differential diagnosis of tension pneumothorax, and its initial resuscitation should include nasogastric tube insertion for immediate decompression.

A prehospital paediatric tension viscerothorax presenting as a tension pneumothorax: a diagnostic dilemma.

This article reports a case of a paediatric pre-hospital tension viscerothorax, and it subsequent management. It also discusses the difficulty in diagnosing this condition in the pre-hospital arena.

Tension gastrothorax: a rare complication.

Tension gastrothorax is herniation of abdominal viscera, stomach in particular, into the thorax that can simulate acute tension pneumothorax. This case reports an acute condition in which percutaneous needle decompression of the distended stomach, through the chest wall, allowed rapid decompression of the tension gastrothorax. After thoracotomy and repair of the ruptured diaphragm, the patient developed re-expansion pulmonary edema that was managed by differential lung ventilation.

Diaphragmatic laceration, partial liver herniation and catamenial pneumothorax.

Catamenial pneumothorax is a recurrent pneumothorax temporally associated with menstruation. Pathogenesis remains debated however pleural endometriosis or diaphragmatic abnormalities are almost always present. We report the case of a 35-year-old woman with recurrent right catamenial pneumothorax. At thoracoscopy a large laceration of the diaphragm with partial intrathoracic liver herniation was seen. Treatment involved repair of the diaphragmatic lacerations, and pleurodesis. This report shows that large diaphragmatic defects may be observed in patients with catamenial pneumothorax.

Thoracic trauma in horses.

Thoracic trauma represents an important cause of morbidity in mortality after injury in human beings and animals. After any form of suspected chest wall trauma, initial emergency management should include assurance of a patent airway and adequate ventilation, along with treatment for shock if present. As with any open wound, tetanus prophylaxis should be instituted. Types of trauma to the thoracic region of the horse include pectoral and axillary lacerations, penetrating chest wounds, flail chest, fractures of the ribs, blunt thoracic trauma, and several potential sequelae that include pneumothorax, pneumomediastinum, hemothorax, pleuritis, fistulae of the sternum or ribs, and diaphragmatic hernia. Emergency management of these various forms of thoracic trauma is discussed.

Hernia diafragmática traumática: reporte de un caso / Traumatic diaphragmatic hernia: case-report

La hernia diafragmática traumática es poco frecuente en niños y continúa siendo una patología de difícil diagnóstico. Es considerada un indicador de gravedad del trauma y presenta una elevada tasa de morbilidad y mortalidad. El objetivo de esta publicación es presentar un caso de hernia diafragmática secundario a un trauma toracoabdominal cerrado. Reportamos el caso de una niña de 8 años atropellada que presentó una hernia diafragmática izquierda y una fractura inestable de pelvis. Evolucionó con un quilotórax y un infarto renal izquierdo que fueron manejados en forma conservadora.

Multi-lobulated cervical pneumatocoele communicating with pyopneumothorax and bronchopleural fistula.

Cervical herniation of lung in infants is a very rare condition which may present as a diagnostic dilemma. Reported here is an infant who presented with a swelling apparently looking like an external laryngocoele but was finally diagnosed as an apical pneumatocoele communicating with pyopneumothorax.

[Diaphragmatic rupture in abdominal trauma]. / Karin Travmasinda Diyfragma Rüptürü.

BACKGROUND: The aim of the study is to evaluate the patients with diaphragmatic rupture due to penetrating or blunt abdominal trauma. METHODS: Thirty-eight patients with diaphragmatic rupture due to penetrating or blunt abdominal trauma were investigated retrospectively. RESULTS: The average age was 41,72 and there were 31 male and seven female patients. The injury forms were penetrating trauma in 22 (58%) and blunt trauma in 16 (42%) cases. Associated abdominal organ injuries were found in 27 (71%) cases. Among 47 diaphragmatic ruptures, 27 (57%) were on the left and 20 (43%) were on the right side. The average diameter of the rupture was 5,45 (1-20) cm. Management of the diaphragmatic rupture and other associated organ injuries were accomplished through laparotomy. Morbidity was developed in 18 cases and mortality in four cases with associated abdominal organ injuries. CONCLUSION: Diaphragmatic rupture results in high morbidity and mortality due to associated organ injuries.

Diaphragmatic hernia from blunt trauma in children with multiple trauma

Introducción. En niños, la hernia diafragmática traumática (HDT) es una condición poco común pero potencialmente letal. En este estudio, se reporta la experiencia del hospital en el diagnóstico y tratamiento de HDT. Material y métodos. Se efectuó un estudio retrospectivo de los expedientes de los niños con HDT tratados en el hospital de 1971 a 1996. Resultados. Cinco hombres y una mujer, de 4 a 12 años de edad fueron tratados. El mecanismo del trauma incluyó accidentes peatonales, vehiculares, por aplastamiento y por caída. En 4 niños se observó dificultad respiratoria. Las lesiones asociadas incluyeron: fractura de base de cráneo, seudosubluxación cervical de C2 sobre C3, fracturas costales, pélvicas y femorales, lesión hepática, esplénica y cecal y hematoma retroperitoneal. Las radiografías iniciales de tórax fueron diagnósticas en 4 casos. Dos obtuvieron un diagnóstico tardío por radiografía de contraste. Todos los pacientes fueron sometidos a exploración transabdominal, con reducción de las vísceras herniadas y sutura del defecto. Dos requirieron esplenorrafia y resección hepática parcial. El paciente con perforación cecal se suturó y drenó. Todos los pacientes están actualmente sanos. Conclusiones. La HDT fue un hallazgo raro entre los niños tratados en el hospital. Su diagnóstico requirió un alto índice de sospecha y radiografía de contraste en los casos dudosos. El abordaje quirúrgico transabdominal fue útil, tanto para la sutura del defecto, como para el diagnóstico y tratamiento de lesiones ocultas

[Diaphragmatic hernias in adults]. / Hernies diaphragmatiques chez l'adulte.

The sliding hiatal hernias are the most usual diaphragmatic hernias in adults. Their recognition and the survey of their complications are performed with esophagoscopy. Antisecretory drugs are efficient in case of esophagitis. Indications for surgery are discussed in young patients with a long-term medical treatment. The paraesophagal hernias even with a total intrathoracic volvulus of the stomach are operated through abdominal approach. The Morgagni hernias are uncommon and rarely symptomatic. The Bochdaleck hernias are exceptionally revealed at adult age. Traumatic hernias occur after penetrating injury or blunt diaphragmatic rupture in automobile accident victims. Association of serious injuries and difficulty to identify the diaphragmatic injury may explain the delay in the diagnosis. Optimal management consists of early repair of the diaphragmatic injury through an abdominal approach, to avoid strangulation of the herniated organs.

Blunt chest trauma.

The spectrum of injuries after blunt chest trauma presents a challenging problem to the emergency physician. The clinician must select among a number of diagnostic tests and therapeutic options after the initial history and physical examination has been performed. Nine clinical entities are discussed: sternal fracture, flail chest, pulmonary contusion, tracheobronchial injuries, myocardial contusion, myocardial rupture, aortic disruption, esophageal perforation, and diaphragm rupture. Emphasis is placed on newer diagnostic modalities available for these conditions.

[Isolated rupture of the right hemidiaphragm with complete herniation of the liver into the thorax. Considerations of diagnosis and therapy]. / Rottura isolata dell'emidiaframma destro con erniazione completa del fegato in torace. Considerazioni sulla diagnosi e sul trattamento.

The Authors report a case of right diaphragmatic hernia due to road-traffic accident. They discuss the problems of early diagnosis because it is delayed for multiple associated lesions or a low index of suspicion. The ratio of laceration of the left side to that of the right is twenty to one. The clinical and diagnostic data best able to lead to a rapid preoperative diagnosis are considered. The Authors recommended early operative treatment and the thoracic approach; thoracoabdominal incisions are more suitable whenever abdominal lesions are coexisting. The Authors stress the use of safety belts with three point fastener which have significantly decreases cranial and abdominal lesions, particularly if associated with two rolls up.

Ruptura diafragmática post-traumática: reporte de 20 casos / Traumatic diaphragmatic hernia: report of 20 cases

De 1977 a 1987, 20 pacientes (18 hombres y 2 mujeres) con ruptura diafragmática izquierda post-traumática fueron manejados en el Servicio de Cirugía General del Hospital de Especialidades del Centro Médico de Occidentes del IMSS; 13 como urgencia (65 por ciento) y 7 de manera electiva (35 por ciento). La hernia fue secundaria a trauma cerrado en el 80 por ciento de los casos. Los síntomas predominantes fueron el dolor torácico (85 por ciento) y la disnea (50 por ciento). El estómago fue la víscera herniada en 16 casos. La placa simple de tórax mostró datos sugestivos en el 95 por ciento de los casos. El cierre primario se logró en el 95 por ciento de los casos, en 8 pacientes fue necesario abordar por vía toraco-abdominal. La morbilidad fue del 50 por ciento (atelectasia 35 por ciento, infección de herida 30 por ciento) y la mortalidad del 10 por ciento

Cardiopulmonary effects of the pneumatic anti-shock garment on swine with diaphragmatic hernia.

The pneumatic anti-shock garment is a widely used prehospital treatment modality for injured patients in shock. Laceration of the hemidiaphragm is a post-traumatic condition that usually is unrecognized during the prehospital phase of trauma care. In order to study the effects of inflation of the pneumatic anti-shock garment on experimental swine with diaphragmatic injury, a premeasured custom-fitted external counter pressure device was applied to the swine both before and after surgically induced laceration to the left hemidiaphragm. At each inflation pressure, several measurements were recorded: blood pressure, heart rate, respiratory rate, tidal volume, pulmonary artery pressures, pulmonary capillary wedge pressure, cardiac output and arterial blood gas determinations. Roentgenograms of the chest were obtained both before and after diaphragmatic laceration and at each inflation pressure after injury. Herniation of abdominal viscera was induced in all swine at 60 millimeters of mercury and was accompanied by statistically significant aberrations in tidal volume, pH, pO2, pCO2, pulmonary capillary wedge pressure and pulmonary artery pressures. Blood pressure increased, in both the injured and noninjured swine, and remained at normal or above normal levels throughout the inflation period in both groups. Extrapolating this phenomenon to the clinical setting when the use of or further inflation of the pneumatic anti-shock garment, or both, is generally determined by blood pressure response alone, patients with blunt trauma and lacerated diaphragms in whom external counter pressure is used may sustain irreversible cerebral hypoxia before any problem is suspected.