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[Late posttraumatic diaphragmatic hernia. A clinical case report]

R De Blasio1, P Maione, U Avallone

  • 1Cattedra di Chirurgia Generale, Università degli Studi di Napoli Federico II.

Minerva Chirurgica
|May 1, 1994
PubMed
Summary

Delayed traumatic diaphragmatic rupture, often presenting as a diaphragmatic hernia, is frequently misdiagnosed due to non-specific symptoms. Early surgical exploration during thoraco-abdominal trauma operations is crucial for timely diagnosis and treatment.

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Area of Science:

  • Trauma Surgery
  • Thoracic Surgery
  • Abdominal Surgery

Background:

  • Traumatic diaphragmatic rupture (TDR) can present with delayed symptoms, leading to diaphragmatic hernia formation.
  • Diagnosis of delayed TDR is challenging due to non-specific clinical presentations and imaging interpretation issues.
  • The incidence and diagnostic challenges of TDR have been examined over the past two decades.

Observation:

  • A case of left-sided traumatic diaphragmatic rupture with delayed presentation and diaphragmatic hernia is presented.
  • Clinical signs of delayed diagnosis are non-specific, often leading to misinterpretation.
  • Intermittent hernial symptoms and failure to suspect diaphragmatic hernia post-injury contribute to diagnostic delays.

Findings:

  • Delayed diagnosis of diaphragmatic hernias following blunt or penetrating trauma is common.

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  • Radiographic interpretation errors and intermittent symptoms are frequent causes of missed diagnoses.
  • Diaphragmatic domes require systematic exploration during thoraco-abdominal trauma surgery.

    • Implications:

    • Prompt surgical exploration of the diaphragm during thoraco-abdominal trauma operations is essential.
    • Early recognition and surgical intervention are critical for managing post-traumatic diaphragmatic hernias.
    • Surgical management for long-standing post-traumatic diaphragmatic hernias is consistent with that for acute cases.