Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Traumatic Diaphragmatic Hernia with Delayed Presentation
- Radiologic Findings
- Chest radiographs show collapsed lung with air-fluid level in left hemithorax.
There is no gastric gas seen at expected location.
CT scans show fluid-filled stomach and collapsed bowel loops with omentum within left hemithorax.
Dilatation of the proximal jejunum as well as stomach is noticed .
One month ago, we missed the diaphragmatic hernia of the splenic flexure of colon on colon study (below).
- Brief Review
- Surgical Findings
Large defect was detected at left hemidiaphragm and herniation of entire stomach and a part of transverse colon with omentum.
There was chronic inflammation around herniated colon and omentum, except stomach.
Adhesive band was noted at ileum.
Discussion
Diaphragmatic rupture occurs in about 5% of patients who have experienced major blunt trauma.
95% of diaphragmatic ruptures are on the left side.
Diaphragmatic rupture is frequently not recognized at the time of trauma and the interval between injury and the onset of symptoms ranged from several weeks to years.
The most common herniated viscera were the stomach and colon.
CT scan identify discontinuity of diaphragm (absent diaphragm sign), especially posterolateral aspect. Herniated organs manifest a "waist" or collar sign.
- References
- 1. Lin YK, Huang BS, Shih CS, Hsu WH, Huaug MH, Lee CH. Traumatic diaphragmatic hernia with delayed presentation. Chung Hua I Hsueh Tsa Chih 1999;62:223-229
2. Worthy SA, Kang EY, Hartman TE, Kwong JS, Mayo JR, Muller NL. Diaphragmatic rupture: CT findings in 11 patients. Radiology 1995;194:885-888
- Keywords
- Diaphragm, Trauma,