Traumatic diaphragmatic hernia is one of the sequela of thoraco-abdominal injury,occurring in about 0.5%-5% of patients presenting post major trauma.Motor vehicle collision is the leading blunt trauma etiology.A high ...Traumatic diaphragmatic hernia is one of the sequela of thoraco-abdominal injury,occurring in about 0.5%-5% of patients presenting post major trauma.Motor vehicle collision is the leading blunt trauma etiology.A high level of suspicion is essential to discover such injuries,as a majority of the patients can be asymptomatic.A case of a successful trans-abdominal laparoscopic reduction and repair of a large acute traumatic diaphragmatic hernia is presented as a video demonstration.We were able to evacuate all intrathoracic air,obliviating the need for a chest tube.Post operatively the patient did well with no complications.If expertise is available,laparoscopic intervention is a feasible option even for large traumatic diaphragmatic hernia preventing the need for a large midline laparotomy incision.展开更多
Purpose： Traumatic diaphragmatic rupture （TDR） needs early diagnosis and operation. However, the early diagnosis is usually difficult, especially in the patients without diaphragmatic hernia. The objective of this ...Purpose： Traumatic diaphragmatic rupture （TDR） needs early diagnosis and operation. However, the early diagnosis is usually difficult, especially in the patients without diaphragmatic hernia. The objective of this study was to explore the early diagnosis and treatment of TDR. Methods： Data of 256 patients with TDR treated in our department between 1994 and 2013 were analyzed retrospectively regarding to the diagnostic methods, percentage of preoperative judgment, incidence of diaphragmatic hernia, surgical procedures and outcome, etc. Two groups were set up ac- cording to the mechanism of injury （blunt or penetrating）. Results： Of 256 patients with a mean age of 32.4 years （9-84）, 218 were male. The average ISS was 26.9 （13-66）; and shock rate was 62.9%. There were 104 blunt injuries and 152 penetrating injuries. Preoperatively diagnostic rate was 90.4% in blunt injuries and 80.3% in penetrating, respectively, P 〈 0.05. The incidence of diaphragmatic hernia was 94.2Z in blunt and 15.1% in penetrating respectively, P 〈 0.005. Thoracotomy was performed in 62 cases, laparotomy in 153, thoracotomy plus laparotomy in 29, and combined thoraco-laparotomy in 12. Overall mortality rate was 12.5% with the average ISS of 41.8; and it was 21.2% in blunt injuries and 6.6% in penetrating, respectively, P 〈 0.005. The main causes of death were hemorrhage and sepsis. Conclusions： Diagnosis of blunt TDR can be easily obtained by radiograph or helical CT scan signs of diaphragmatic hernia. For penetrating TDR without hernia, ＂offside sign＂ is helpful as initial assessment. CT scan with coronal/sagittal reconstruction is an accurate technique for diagnosis. All TDR require operation. Penetrating injury has a relatively better prognosis.展开更多
Traumatic diaphragmatic hernia （TDH） is an uncommon injury and a marker of severe trauma.This injury is rarely associated with pelvic ring fracture,although TDH is one of the most dangerous comorbidities of such fra...Traumatic diaphragmatic hernia （TDH） is an uncommon injury and a marker of severe trauma.This injury is rarely associated with pelvic ring fracture,although TDH is one of the most dangerous comorbidities of such fractures.Since this condition is easily misdiagnosed in emergency cases,we reported two cases and analyzed the clinical symptoms,diagnosis,treatment,and outcome of this comorbidity.Based on these results,we recommended an appropriate method for diagnosis and treatment and proposed a contraindication in treating TDH associated with pelvic fracture.展开更多
Introduction: Traumatic right diaphragmatic hernia is an extremely rare entity, given the protection afforded by the liver. Clinical Case: A 51-year-old women who suffered a road-traffic accident presented with a heav...Introduction: Traumatic right diaphragmatic hernia is an extremely rare entity, given the protection afforded by the liver. Clinical Case: A 51-year-old women who suffered a road-traffic accident presented with a heavy sensation and several episodes of moderate pain in the left hemithorax. Physical and radiological exams revealed a traumatic right hernia. Discussion: The diagnosis of hernia should be established as quickly as possible to reduce morbidity and mortality. Treatment of the injury is always surgical and outcome is invariably positive. Conclusion: The diagnosis of diaphragmatic hernia should always be considered in patients suffering road-traffic accidents to allow early diagnosis and successful treatment.展开更多
Objective： To review the epidemiological feature, clinical and diagnostic data of post-traumatic diaphragmatic hernia （TDH） associated with pelvis fracture reported in recent 10 years. Methods ： A 10-year retrosp...Objective： To review the epidemiological feature, clinical and diagnostic data of post-traumatic diaphragmatic hernia （TDH） associated with pelvis fracture reported in recent 10 years. Methods ： A 10-year retrospective study was undertaken to analyze the incidence, diagnosis, management, morbidity and mortality of patients with traumatic diaphragmatic hernia associated with pelvis fractures. A total of 46 cases in our country were reviewed. Results： The incidence of TDH associated with pelvis fractures was relatively rare and the diagnosis was often delayed or missed. A total of 72.34 % of these patients were diagnosed as TDH associated with pelvis fractures after injury for 36 hours to 1 week. Although the trans-thorax approach was preferred for surgical closure in the acute phase, its mortality still reached 8.51%. Conclusions： TDH associated with pelvis fractures is difficult to be diagnosed because of its varied clinical and radiological signs and the patients may not present with symptoms for a long time after injury. In clinical, a high index of suspicion with appropriate examination is the mainstay of management, which can be helpful in prognosis.展开更多
文摘Traumatic diaphragmatic hernia is one of the sequela of thoraco-abdominal injury,occurring in about 0.5%-5% of patients presenting post major trauma.Motor vehicle collision is the leading blunt trauma etiology.A high level of suspicion is essential to discover such injuries,as a majority of the patients can be asymptomatic.A case of a successful trans-abdominal laparoscopic reduction and repair of a large acute traumatic diaphragmatic hernia is presented as a video demonstration.We were able to evacuate all intrathoracic air,obliviating the need for a chest tube.Post operatively the patient did well with no complications.If expertise is available,laparoscopic intervention is a feasible option even for large traumatic diaphragmatic hernia preventing the need for a large midline laparotomy incision.
文摘Purpose： Traumatic diaphragmatic rupture （TDR） needs early diagnosis and operation. However, the early diagnosis is usually difficult, especially in the patients without diaphragmatic hernia. The objective of this study was to explore the early diagnosis and treatment of TDR. Methods： Data of 256 patients with TDR treated in our department between 1994 and 2013 were analyzed retrospectively regarding to the diagnostic methods, percentage of preoperative judgment, incidence of diaphragmatic hernia, surgical procedures and outcome, etc. Two groups were set up ac- cording to the mechanism of injury （blunt or penetrating）. Results： Of 256 patients with a mean age of 32.4 years （9-84）, 218 were male. The average ISS was 26.9 （13-66）; and shock rate was 62.9%. There were 104 blunt injuries and 152 penetrating injuries. Preoperatively diagnostic rate was 90.4% in blunt injuries and 80.3% in penetrating, respectively, P 〈 0.05. The incidence of diaphragmatic hernia was 94.2Z in blunt and 15.1% in penetrating respectively, P 〈 0.005. Thoracotomy was performed in 62 cases, laparotomy in 153, thoracotomy plus laparotomy in 29, and combined thoraco-laparotomy in 12. Overall mortality rate was 12.5% with the average ISS of 41.8; and it was 21.2% in blunt injuries and 6.6% in penetrating, respectively, P 〈 0.005. The main causes of death were hemorrhage and sepsis. Conclusions： Diagnosis of blunt TDR can be easily obtained by radiograph or helical CT scan signs of diaphragmatic hernia. For penetrating TDR without hernia, ＂offside sign＂ is helpful as initial assessment. CT scan with coronal/sagittal reconstruction is an accurate technique for diagnosis. All TDR require operation. Penetrating injury has a relatively better prognosis.
文摘Traumatic diaphragmatic hernia （TDH） is an uncommon injury and a marker of severe trauma.This injury is rarely associated with pelvic ring fracture,although TDH is one of the most dangerous comorbidities of such fractures.Since this condition is easily misdiagnosed in emergency cases,we reported two cases and analyzed the clinical symptoms,diagnosis,treatment,and outcome of this comorbidity.Based on these results,we recommended an appropriate method for diagnosis and treatment and proposed a contraindication in treating TDH associated with pelvic fracture.
文摘Introduction: Traumatic right diaphragmatic hernia is an extremely rare entity, given the protection afforded by the liver. Clinical Case: A 51-year-old women who suffered a road-traffic accident presented with a heavy sensation and several episodes of moderate pain in the left hemithorax. Physical and radiological exams revealed a traumatic right hernia. Discussion: The diagnosis of hernia should be established as quickly as possible to reduce morbidity and mortality. Treatment of the injury is always surgical and outcome is invariably positive. Conclusion: The diagnosis of diaphragmatic hernia should always be considered in patients suffering road-traffic accidents to allow early diagnosis and successful treatment.
文摘Objective： To review the epidemiological feature, clinical and diagnostic data of post-traumatic diaphragmatic hernia （TDH） associated with pelvis fracture reported in recent 10 years. Methods ： A 10-year retrospective study was undertaken to analyze the incidence, diagnosis, management, morbidity and mortality of patients with traumatic diaphragmatic hernia associated with pelvis fractures. A total of 46 cases in our country were reviewed. Results： The incidence of TDH associated with pelvis fractures was relatively rare and the diagnosis was often delayed or missed. A total of 72.34 % of these patients were diagnosed as TDH associated with pelvis fractures after injury for 36 hours to 1 week. Although the trans-thorax approach was preferred for surgical closure in the acute phase, its mortality still reached 8.51%. Conclusions： TDH associated with pelvis fractures is difficult to be diagnosed because of its varied clinical and radiological signs and the patients may not present with symptoms for a long time after injury. In clinical, a high index of suspicion with appropriate examination is the mainstay of management, which can be helpful in prognosis.
