Posters
Presentation Type
Poster
Discipline Track
Community/Public Health
Abstract Type
Case Report
Abstract
Background. Diaphragmatic injuries (DI) represent less than 1% of traumatic injuries; they are a marker of severe trauma due to associated injuries, although they often go undiagnosed as they remain hidden. If undetected, delayed herniation and strangulation of the abdominal organs into the chest cavity will result as the defect in the diaphragm is not repaired. DI occurs from penetrating or blunt trauma. The former occurs in approximately 67% of cases; direct injury to the diaphragm caused by automobile accidents has been reported. The remaining third is due to falls and crush injuries. Blunt trauma causes larger tears, even bilateral. Mortality from DI reaches 25% of cases and is higher in patients with blunt mechanisms of injury in the acute setting due to associated injuries. Mortality due to delayed presentation with hernia of abdominal contents into the chest due to previous penetrating trauma is 20% and increases with intestinal strangulation.
Case presentation. Male, two years, and eight months-old, admitted to the emergency department due to thoraco-abdominal trauma due to being crushed by a truck tire. Tachypnea and stable vital signs were observed. Chest X-ray revealed elevated diaphragm and right pleural effusion. The patient continued to have dyspnea. Abdominal ultrasound confirmed elevation of the hemidiaphragm. Computed tomography of the chest showed the hepatic gland within the chest cavity. In the operating room, a right lateral thoracotomy was performed, observing diaphragmatic rupture. To correct and restore the hepatic gland to its normal anatomical site, the ruptured diaphragm was sutured with 2-0 Prolene®, supported with a bovine pericardium band, and subsequently a 12-Fr® chest tube was placed. In the end, it was closed by planes.
Conclusions. The patient presented a blunt diaphragmatic injury. Intra-abdominal pressure increased above the tensile strength of diaphragmatic tissue. The patient evolved favorably in the postoperative period. He was kept under observation for ten days and was discharged without complications. After discharge, follow-up was performed without observing a diaphragmatic hernia or other injury.
Academic/Professional Position
Other
Academic/Professional Position (Other)
Medical Doctor
Recommended Citation
Rosales Martínez, Juan; Lara Duck, Manlio F.; Gutiérrez Sierra, Antonio; and Mayek Pérez, Netzahualcoyotl, "Diaphragmatic Rupture Due To Closed Thoracobdominal Trauma: A Case Report" (2023). Research Symposium. 57.
https://scholarworks.utrgv.edu/somrs/2022/posters/57
Included in
Diaphragmatic Rupture Due To Closed Thoracobdominal Trauma: A Case Report
Background. Diaphragmatic injuries (DI) represent less than 1% of traumatic injuries; they are a marker of severe trauma due to associated injuries, although they often go undiagnosed as they remain hidden. If undetected, delayed herniation and strangulation of the abdominal organs into the chest cavity will result as the defect in the diaphragm is not repaired. DI occurs from penetrating or blunt trauma. The former occurs in approximately 67% of cases; direct injury to the diaphragm caused by automobile accidents has been reported. The remaining third is due to falls and crush injuries. Blunt trauma causes larger tears, even bilateral. Mortality from DI reaches 25% of cases and is higher in patients with blunt mechanisms of injury in the acute setting due to associated injuries. Mortality due to delayed presentation with hernia of abdominal contents into the chest due to previous penetrating trauma is 20% and increases with intestinal strangulation.
Case presentation. Male, two years, and eight months-old, admitted to the emergency department due to thoraco-abdominal trauma due to being crushed by a truck tire. Tachypnea and stable vital signs were observed. Chest X-ray revealed elevated diaphragm and right pleural effusion. The patient continued to have dyspnea. Abdominal ultrasound confirmed elevation of the hemidiaphragm. Computed tomography of the chest showed the hepatic gland within the chest cavity. In the operating room, a right lateral thoracotomy was performed, observing diaphragmatic rupture. To correct and restore the hepatic gland to its normal anatomical site, the ruptured diaphragm was sutured with 2-0 Prolene®, supported with a bovine pericardium band, and subsequently a 12-Fr® chest tube was placed. In the end, it was closed by planes.
Conclusions. The patient presented a blunt diaphragmatic injury. Intra-abdominal pressure increased above the tensile strength of diaphragmatic tissue. The patient evolved favorably in the postoperative period. He was kept under observation for ten days and was discharged without complications. After discharge, follow-up was performed without observing a diaphragmatic hernia or other injury.