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Traumatic diaphragmatic hernia: delayed presentation with tension viscerothorax--lessons to learn
M S Al Skaini1, A Sardar, H Haroon
1Armed Forces Hospitals Southern Region, Saudi Arabia.
Annals of the Royal College of Surgeons of England
|March 15, 2013
Summary
Diaphragmatic rupture from trauma can be initially missed. Delayed diagnosis can lead to rare complications like tension viscerothorax, requiring prompt intervention and surgical repair.
Area of Science:
- Trauma surgery
- Thoracic surgery
- Abdominal surgery
Background:
- Diaphragmatic rupture is a severe consequence of thoracoabdominal trauma.
- Initial diagnosis of diaphragmatic injury can be challenging.
- Delayed presentation of diaphragmatic injuries is uncommon.
Observation:
- A patient with blunt abdominal trauma experienced a missed diaphragmatic injury.
- The injury presented two years later as a left tension viscerothorax.
- Tension viscerothorax is a rare and infrequently recognized condition.
Findings:
- Nasogastric tube insertion successfully de-escalated the acute emergency.
- The diaphragmatic hernia was subsequently repaired electively.
- This case highlights a rare delayed presentation of diaphragmatic rupture.
Implications:
- Emphasizes the importance of considering diaphragmatic injury in patients with thoracoabdominal trauma, even with delayed presentation.
- Highlights tension viscerothorax as a rare but critical complication of missed diaphragmatic rupture.
- Demonstrates successful management of a delayed diaphragmatic hernia with tension viscerothorax.
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