alexa Post-Traumatic Peritoneopericardial Diaphragmatic Hernia: A Case Report | Open Access Journals
ISSN: 2167-1222
Journal of Trauma & Treatment
Make the best use of Scientific Research and information from our 700+ peer reviewed, Open Access Journals that operates with the help of 50,000+ Editorial Board Members and esteemed reviewers and 1000+ Scientific associations in Medical, Clinical, Pharmaceutical, Engineering, Technology and Management Fields.
Meet Inspiring Speakers and Experts at our 3000+ Global Conferenceseries Events with over 600+ Conferences, 1200+ Symposiums and 1200+ Workshops on
Medical, Pharma, Engineering, Science, Technology and Business

Post-Traumatic Peritoneopericardial Diaphragmatic Hernia: A Case Report

Katarzyna Szwalbe*, Piotr Misiak and Artur Terlecki

Department of Thoracic Surgery, General and Oncological Surgery, University Clinical Hospital No.2, Military Memorial Medical Academy, Central Veterans’ Hospital, Medical University of Łódź, Poland

*Corresponding Author:
Katarzyna Szwalbe
Department of Thoracic Surgery, General and
Oncological Surgery, University Clinical Hospital No.2
Military Memorial Medical Academy
Central Veterans’ Hospital, Medical University of Łódź, Poland
Tel: +48422725803
E-mail: szwalbe@wp.pl

Received date: February 10, 2017; Accepted date: March 09, 2017; Published date: March 11, 2017

Citation: Szwalbe K, Misiak P, Terlecki A (2017) Post-Traumatic Peritoneopericardial Diaphragmatic Hernia: A Case Report. J Trauma Treat 6:364. doi:10.4172/2167-1222.1000364

Copyright: © 2017 Szwalbe K, et al. This is an open-access article distributed under the terms of the creative commons attribution license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Visit for more related articles at Journal of Trauma & Treatment

Abstract

Objective: Bisphenol-A (BPA) is a xenoestrogen used in many consumer products. Here we present a case of dysfunctional uterine bleeding after exposure to dental sealant containing BPA.

Design: Case Report

Setting: Academic Medical Center

Intervention: Dysfunctional uterine bleeding was diagnosed, and no therapy was initiated.

Results: The patient continued to experience bleeding following each exposure.

Conclusion: Female patients undergoing dental procedures that use BPA containing compounds may experience dysfunctional bleeding.

Case Report

A 60-year-old woman was admitted to the Department in June, 2008, following an automobile accident. She was diagnosed with cerebral concussion, left clavicular fracture and fracture of the 4th left rib. The patient made a complete recovery following treatment of these injuries. Despite several hospitalizations between 2008 and 2012 for recurrent abdominal pain, the correct diagnosis was not made until her hospitalization in November, 2012. During this hospitalization, chest X-rays revealed multiple gas shadows overlying the cardiac silhouette. Further investigation with computed tomography illustrated a trans-diaphragmatic bowel herniation into the anterior mediastinum (Figure 1).

trauma-treatment-bowel-pericardium

Figure 1: CT scan shows bowel in the pericardium.

Based on this radiography, the patient was admitted to the Department of Thoracic Surgery, General and Oncological Surgery on 26 November 2012. On admission, the patient was in good overall condition. She complained of severe abdominal pain and bloating. She was qualified for surgical intervention. A planned surgical procedure under general anesthesia was performed.

The abdominal cavity was opened via a midline incision in the epigastrium. In the central portion of the diaphragm, a round defect measuring 5 cm across was observed. The transverse colon with its overlying omentum was determined to have herniated from the pericardial space, through the diaphragmatic defect, and into the mediastinum. The herniated bowel was manually reduced with ease (Figure 2) and the incision was closed with interrupted sutures. The postoperative period was uneventful with the patient being discharged on the second postoperative day.

trauma-treatment-herniated-bowel

Figure 2: Pericardio-diaphragmatic tear after removal of herniated bowel.

Discussion

Traumatic diaphragmatic injury is relatively rare and has been reported in 0,8% to 1,6% of patients hospitalized due to blunt trauma [2]. The underlying mechanism of diaphragmatic rupture in blunt trauma is due to a sudden increase in intra-abdominal pressure, which may result in a linear tearing of the diaphragm. The normal positive gradient of 7 cm to 20 cm H2O can rise to as high as 100 cm H2O. In some cases, a small linear tear that occurs at the time of injury can suddenly enlarge due to this increase in the gradient in thoracoabdominal pressure secondary to coughing or lifting of heavy weights [3]. Left-sided rupture occurs in 68.5% of patients, 24.2% of ruptures occur on the right side, 1.5% bilaterally, and 0.9% involve pericardial rupture [3,4].

The left diaphragm is more commonly involved, as its weakest point is located on the left posterolateral aspect of the pleuroperitoneal membrane. On the other hand, the right diaphragm is able to withstand greater intra-abdominal pressure gradients due to its being protected by the liver. The organs that most commonly herniate into the thorax include the stomach, spleen, colon, small bowel and liver.

Herniation of organs into the thoracic cavity imparts additional pressure on the lungs and causes the mediastinum to shift. This may lead to circulatory and respiratory disturbances. Grimes divided the clinical manifestation of the diaphragmatic rupture into three phases: The first is an acute phase at the time of injury to the diaphragm; the second is a delayed phase associated with transient herniation of the viscera, thus accounting for absent or intermittent non-specific symptoms; and the third is an obstruction phase involving complications associated with those of a long-standing herniation: obstruction, strangulation and posterior rupture [3].

The diagnosis in the acute phase can be difficult to make and is frequently overlooked because of serious related injuries and shock. Moreover, the diagnosis is delayed in up to 30% to 50% of cases; this delay can range from 7 days to 40 years [5]. Chest radiography is commonly the initial diagnostic test. The specific signs include intestinal air or a nasogastric tube above the hemidiaphragm, marked elevation of the hemidiaphragm, as well as mediastinal shift. The sensitivity of chest radiography has been reported to be as high as 70%. Computed tomography has a sensitivity of 75% to 90% and specificity approaching 100% [5,6].

The surgical approach includes laparotomy, thoracotomy or both, the decision being dependent upon the associated injures and the condition of the patient at the time of admission. Laparotomy is more appropriate in unstable patients when associated intra-abdominal injuries are present or suspected. Thoracotomy is more suitable for stable patients without intra-abdominal injuries, contralateral diaphragmatic injuries or a delayed diagnosis [4,6].

Conclusion

An accurate diagnosis of diaphragmatic rupture in trauma patients is difficult to carry out, resulting in decreased quality of life due to delayed treatment. Emergency physician and trauma surgeon should keep this diagnosis in mind in patients with a history of thoracoabdominal trauma. In delayed cases, a thoracotomy is preferred because of the possible presence of adhesions. In this case the incision was closed with interrupted sutures but another problem with delayed treatment can be atrophy of the diaphragm, which may require reconstruction with prosthesis mesh. In conclusion, although the diaphragmatic hernias are rare and the clinical manifestation can be variable, they should always be considered in the trauma patient.

References

Select your language of interest to view the total content in your interested language
Post your comment

Share This Article

Relevant Topics

Recommended Conferences

Article Usage

  • Total views: 355
  • [From(publication date):
    March-2017 - Aug 17, 2017]
  • Breakdown by view type
  • HTML page views : 321
  • PDF downloads :34
 
 

Post your comment

captcha   Reload  Can't read the image? click here to refresh

Peer Reviewed Journals
 
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
International Conferences 2017-18
 
Meet Inspiring Speakers and Experts at our 3000+ Global Annual Meetings

Contact Us

Agri, Food, Aqua and Veterinary Science Journals

Dr. Krish

agrifoodaquavet@omicsonline.com

1-702-714-7001 Extn: 9040

Clinical and Biochemistry Journals

Datta A

clinical_biochem@omicsonline.com

1-702-714-7001Extn: 9037

Business & Management Journals

Ronald

business@omicsonline.com

1-702-714-7001Extn: 9042

Chemical Engineering and Chemistry Journals

Gabriel Shaw

chemicaleng_chemistry@omicsonline.com

1-702-714-7001 Extn: 9040

Earth & Environmental Sciences

Katie Wilson

environmentalsci@omicsonline.com

1-702-714-7001Extn: 9042

Engineering Journals

James Franklin

engineering@omicsonline.com

1-702-714-7001Extn: 9042

General Science and Health care Journals

Andrea Jason

generalsci_healthcare@omicsonline.com

1-702-714-7001Extn: 9043

Genetics and Molecular Biology Journals

Anna Melissa

genetics_molbio@omicsonline.com

1-702-714-7001 Extn: 9006

Immunology & Microbiology Journals

David Gorantl

immuno_microbio@omicsonline.com

1-702-714-7001Extn: 9014

Informatics Journals

Stephanie Skinner

omics@omicsonline.com

1-702-714-7001Extn: 9039

Material Sciences Journals

Rachle Green

materialsci@omicsonline.com

1-702-714-7001Extn: 9039

Mathematics and Physics Journals

Jim Willison

mathematics_physics@omicsonline.com

1-702-714-7001 Extn: 9042

Medical Journals

Nimmi Anna

medical@omicsonline.com

1-702-714-7001 Extn: 9038

Neuroscience & Psychology Journals

Nathan T

neuro_psychology@omicsonline.com

1-702-714-7001Extn: 9041

Pharmaceutical Sciences Journals

John Behannon

pharma@omicsonline.com

1-702-714-7001Extn: 9007

Social & Political Science Journals

Steve Harry

social_politicalsci@omicsonline.com

1-702-714-7001 Extn: 9042

 
© 2008-2017 OMICS International - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version