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Traumatic diaphragmatic hernia in children
Insights
Diaphragmatic rupture in children from blunt trauma is rare and often diagnosed late, leading to potential complications. Early recognition and treatment of traumatic diaphragmatic injury in pediatric patients are crucial for better outcomes.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Diaphragmatic Injuries
Background:
- Traumatic diaphragmatic rupture is uncommon in pediatric patients.
- Delayed diagnosis can lead to significant gastrointestinal or respiratory complications.
Purpose of the Study:
- To review the diagnosis, management, and outcomes of diaphragmatic rupture in children resulting from blunt trauma.
- To highlight the challenges associated with delayed diagnosis in pediatric traumatic diaphragmatic injuries.
Main Methods:
- Retrospective review of 11 pediatric patients with traumatic diaphragmatic rupture treated between 1950 and 1977.
- Analysis of injury mechanisms, associated injuries, diagnostic timelines, surgical repair methods, and patient outcomes.
Main Results:
- All injuries resulted from blunt trauma, predominantly automobile accidents, affecting the left hemidiaphragm.
- Nine patients had associated injuries, including fractures, head, and spleen trauma.
- Six ruptures were recognized acutely; five were diagnosed late (2 months to 3 years post-trauma) with presenting symptoms.
- Abdominal repair was performed in 10 patients; one underwent thoracic repair.
- One death occurred due to severe craniocerebral injury; minor complications were noted in five survivors.
Conclusions:
- Traumatic diaphragmatic rupture in children, though rare, requires vigilance for timely diagnosis and intervention.
- Delayed diagnosis can lead to serious morbidity, emphasizing the need for high suspicion in pediatric trauma cases.
- Surgical repair, predominantly abdominal, is effective, with a low mortality rate when associated severe injuries are managed.
Abstract:
Because of its rarity in children the diagnosis of diaphragmatic hernia due to trauma is often delayed, sometimes resulting in gastrointestinal or respiratory complaints or obstruction of the small intestine. Eleven children with rupture of the diaphragm were seen between 1950 and 1977. All injuries were due to blunt trauma sustained in automobile-related accidents; all involved the left hemidiaphragm. Nine children had associated injuries, most commonly fractures, and injury to the head and spleen. In six children the diaphragmatic rupture was recognized and treated at the time of injury. The other five presented with gastrointestinal or respiratory symptoms from 2 months to 3 years after the trauma. Repair was through the abdomen in 10 patients and the chest in 1. There was only one death from an associated severe craniocerebral injury. Complications developed in five surviving patients but were relatively minor.