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Acute blunt traumatic rupture of the diaphragm in children
Insights
Blunt trauma can cause acute diaphragm rupture in infants and children. Early surgical repair is crucial for respiratory function, especially in the youngest patients, and abdominal approaches can aid complex repairs.
Area of Science:
- Trauma Surgery
- Pediatric Surgery
- Thoracic Surgery
Background:
- Acute diaphragm rupture is a rare but serious consequence of blunt force trauma.
- Diagnosis and management in pediatric patients present unique challenges due to anatomical and physiological differences.
- Timely intervention is critical to prevent cardiorespiratory compromise.
Observation:
- A 10-month-old infant presented with acute diaphragm rupture, representing the youngest reported case.
- The infant required immediate surgical repair due to respiratory distress caused by herniated abdominal contents.
- A 10-year-old boy with a fractured femur also sustained a diaphragmatic laceration involving the pericardium.
Findings:
- Emergency diaphragmatic repair was successfully performed in both pediatric patients.
- The infant's repair addressed life-threatening respiratory compromise from diaphragmatic rupture.
- The boy's diaphragmatic laceration, including the pericardium, was repaired using an abdominal approach.
Implications:
- This case series highlights the youngest reported infant with traumatic diaphragm rupture, emphasizing the need for prompt diagnosis and surgical intervention in pediatric trauma.
- The successful use of an abdominal approach for diaphragmatic and pericardial repair in the older child demonstrates its utility in complex cases.
- These findings underscore the importance of considering diaphragmatic injury in pediatric blunt trauma and the effectiveness of surgical management.
Abstract:
Two patients had acute rupture of the diaphragm from blunt trauma. One was a 10 1/2-month-old infant, the youngest yet reported with this condition to our knowledge. He required emergency repair because of increasing encroachment on respiratory function by the hernial contents during the early hours of observation. The second patient, a ten-year-old boy with an associated fractured femur, underwent successful repair of a diaphragmatic laceration that included the pericardium. In this case the approach via the abdomen, used to rule out associated intraperitoneal injuries, actually facilitated the repair, particularly that of the diaphragmatic pericardium.