Traumatic diaphragmatic hernia (TDH) occurs in about 5 percent of blunt and penetrating abdominal injury and 10 percent of victims of penetrating chest injury. Ten percent of such injuries become apparent only months or years later after the initial trauma. The TDH patient is at risk for surgical complications, including pulmonary aspiration, tension pneumothorax, hypoxemia, strangulation and necrosis of entrapped bowel and hemodynamic instability. Diagnosis and proper management of TDH is essential in order to minimize such complications. The anesthetic management of a patient with previously unsuspected, chronic traumatic diaphragmatic hernia is discussed.
Human ; Male ; HERNIA, DIAPHRAGMATIC ; HERNIA, DIAPHRAGMATIC, TRAUMATIC ; PNEUMOTHORAX

Traumatic diaphragmatic hernia may show a delayed presentation and it rarely simulates pleural effusion. We report here on two asymptomatic cases that were diagnosed by performing chest CT.
Hernia, Diaphragmatic ; Hernia, Diaphragmatic, Traumatic* ; Omentum ; Pleural Effusion* ; Tomography, X-Ray Computed

A diaphragmatic hernia in adult can result from delayed presentation of congenital or traumatic diaphragmatic defect. of all congenital diaphragmatic hernia, 5~25% present beyond the neonatal period. Diaphragmatic injury due to blunt or penetrating truncal trauma is relatively common, and can be missed during immediate posttraumatic period. If the diaphragmatic injury is not recognized at the time of the initial trauma, the patient may recover and remain symptom free, or suffer from chronic nonspecific abdominal and/or chest symptoms. After a variable interval acute symptom associated with intestinal obstruction or strangulation can arise because of a herniation of the abdominal organs through the diaphragmatic defect. A delay in diagnosis may occur and be associated with a high morbidity, so a careful history and examination, are essential for the successful management of patients, as is maintaining an awareness of the possibility of the delayed presentation of traumatic diaphragmatic hernia and its complication. We present a 35-years-old male patient with delayed presenting, traumatic diaphragmatic hernia, and discuss a literature a review.
Adult* ; Diagnosis ; Hernia, Diaphragmatic ; Hernia, Diaphragmatic, Traumatic* ; Humans ; Intestinal Obstruction ; Male ; Thorax

A traumatic diaphragmatic hernia is a rare combined problem involving injuries to the thorax and abdomen that may not be diagnosed at the time of injury. Surgical management is mandatory when the patient displays any signs of bowel strangulation due to the herniation because a herniated bowel has a very high risk of necrosis or perforation. Four patients were diagnosed with delayed traumatic diaphragmatic hernia 14 to 96 months after injury. In two patients, the diaphragmatic injury was missed at the time of injury. Reduction and diaphragm repair surgery were performed. One diaphragm was repaired with artificial mesh. Traumatic diaphragmatic injury is caused by a blunt or penetrating injury to the abdomen or thorax. After migration of the intra-abdominal contents into the chest, a narrow herniation defect can disturb the bowel circulation and passage of bowel contents. Early detection and reduction, and repair surgery are mandatory for patients with a delayed presentation of complicated traumatic diaphragmatic hernia. Any patient with injury around the thorax or upper abdomen should be examined carefully considering the possibility of diaphragmatic hernia. Even if diaphragmatic injuries are not found in the initial evaluation, a radiology examination in a short period of time can correct the missed diagnosis of traumatic diaphragmatic hernia.
Abdomen ; Delayed Diagnosis ; Diagnosis ; Diaphragm ; Hernia, Diaphragmatic ; Hernia, Diaphragmatic, Traumatic ; Humans ; Necrosis ; Thorax

Between January 1976 and March 1997, six patients with delayed presentation of traumatic diaphragmatic hernia occured among the 52 patients of traumatic diaphragm rupture, of whom four males and two females, five by blunt trauma and one by stab wound, one was right side and the rest were left side. In all patients, reduction of herniated organs was accomplished by thoracotomy or thoracotomy with extension to abdomen. Suspicion of the diaphragmatic ruture from the acute traumatic chest injured patient is important and we can use the videothoracoscopy for evaluation and treatment of the traumatic diaphragm rupture.
Abdomen ; Diaphragm ; Female ; Hernia ; Hernia, Diaphragmatic, Traumatic* ; Humans ; Male ; Rupture ; Thoracotomy ; Thorax ; Wounds, Stab

Traumatic diaphragmatic injuries in infants and children are uncommon. Late presentation of such an injury is well recognised in adults but is exceptionally rare in children. Because of the increased compliance of the thoracic cage in children, rupture of the diaphragm can occur without signs of external injury. Morbidity and mortality can be minimized by a high index of suspicion, prompt recognition, and surgical repair of even the smallest diaphragmatic injury. We present a case of delayed presentation of traumatic diagphragmatic hernia in a boy of 10 months.
Adult ; Child* ; Compliance ; Diaphragm ; Hernia ; Hernia, Diaphragmatic, Traumatic* ; Humans ; Infant ; Male ; Mortality ; Rupture

We report a distinctive case of a large traumatic diaphragmatic hernia (TDH) that presented 36-years after the preceding injury. We believe this case represents the most delayed (TDH) presentation ever reported in Korea. This paper describes the particular presentation, including the operative and postoperative management of this patient. We also review the management of long delayed TDH presentation and the postoperative issues concerning thoracic cavity dead space and propensity of the repaired diaphragm for developing abdominal compartment syndrome.
Diaphragm ; Hernia ; Hernia, Diaphragmatic, Traumatic ; Humans ; Intra-Abdominal Hypertension ; Korea ; Thoracic Cavity

The diaphragmatic injury is often associated with thoracic or abdominal trauma. This injury has wide spectrum of symptoms from minimal discomfort to strangulation of the herniated organ. Herein we report a case of delayed presentation of traumatic diaphragmatic hernia treated surgically. The case was discovered about five years later after fall down accident. The patient complained intermittent chest discomfort and pain at the first visit of our department. On physical examination, slightly decreased breathing sound was noted in right lower lung field. The thoracic CT and MRI findings were suggestive of right side diaphragmatic injury with herniation of liver. Under general anesthesia, we confirmed diaphragmatic hernia through thoracoscopic evaluation of right thorax. Unfortunately it was too hard to put liver back into peritoneal cavity through the thoracoscopic procedures. Then we performed abdominal laparotomy and the herniated liver was reduced. The patient was tolerated well and recovered without complications.
Anesthesia, General ; Diaphragm ; Hernia ; Hernia, Diaphragmatic ; Hernia, Diaphragmatic, Traumatic* ; Humans ; Laparotomy ; Liver ; Lung ; Magnetic Resonance Imaging ; Peritoneal Cavity ; Physical Examination ; Respiratory Sounds ; Thorax

Traumatic rupture of the diaphragm is uncommon, occurring in 5.3% of cases where blunt trauma to the aMomen required laparotomy and in less than 196 of cases of blunt chest trauma. It is not found in the immediate postinjury phase in 33% to 67% of cases. This eventurates in delayed manifestations, ususally involving herniation of abdominal contents into the chest. We report our experience of the anesthetic management in a patient with old traumatic diaphragmatic hernia for orthopaedic surgery. Following epidural anesthesia, tracheal intubation was done and anesthesia was maintained with isoflurane, narcotics and O2. A careful monitoring was done for adequate oxygenation and ventilation. One month after operation he was transferred to the other hospital for recurred diaphragmatic hemia.
Anesthesia ; Anesthesia, Epidural ; Diaphragm ; Hernia, Diaphragmatic, Traumatic* ; Humans ; Intubation ; Isoflurane ; Laparotomy ; Narcotics ; Oxygen ; Rupture ; Thorax ; Ventilation

Adult ; Female ; Fractures, Bone ; complications ; Hernia, Diaphragmatic, Traumatic ; diagnosis ; etiology ; Humans ; Pelvic Bones ; injuries