Subacute presentation of spontaneous diaphragmal rupture: case report
Abstract
Background: Diaphragmatic injuries are relatively rare and present with non specific symptoms and signs. Late discoveries are almost a rule in all but the most evident cases. Many patients are observed or even treated for suspected other conditions, most often musculosceletal disorders.
Patients and methods: We report a case of a 14-year-old boy who presented with left lumbar pain and developed peritonitis six days after strenuous training. A chest X-ray revealed abdominal viscera in the left hemithorax. A large posterolateral rupture of the left diaphragm was found at laparotomy together with herniation of the stomach, spleen and colon. The stomach was perforated and partialy necrotic. Afer partial gastrectomy, repositioning and diaphragmal repair the patient recovered well.
Conclusions: If pain in toracoabdominal region is a predominant sign after trauma or endogenous strain, one should consider the posibility of ruptured diaphragm and make a chest X-ray. Operation of diaphragmal hernia is necessary and garanties good results when treated on time.
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References
Arak T, Solheim K, Pillgram-Larsen J. Diaphragmatic injuries. Injury 1997; 28: 113–7.
Chen JC, Wilson SE. Diaphragmatic injuries: recognition and management in sixty-two patients. Am Surg 1991; 57: 810–5.
Cubukcu A, Paksoy M, Gonullun NN, Sirin F, Dulger M. Traumatic rupture of diaphragm. Int J Clin Pract 2000; 54: 19–21.
Shah R, Sabanathan S, Mearns AJ, Choudhury AK. Traumatic rupture of the diaphragm. Ann Thorac Surg 1995; 60: 1444–9.
Lee WC, Chen RJ, Fang JF, Wang CC, Chen HY, Hwang TL, et al. Rupture of the diaphragm after blunt trauma. Eur J Surg 1994; 160: 479–83.
Symbas PN, Vlasis SE, Hetcher C Jr. Blunt and penetrating diaphragmatic injuries with or without herniation of organs into the chest. Ann Thorac Surg 1986; 42: 158–62.
Symbas PN. Diaphragmatic injuries. In: Shields TW, ed. General thoracic surgery. Philadelphia: Lippincott Williams & Wilkins; 2005. p. 1006–14.
Leoncini G, Iurilli L, Lupi P, Catambone U. Intrathoracic perforation of the gastric fundus as a late complication of an unknown post-traumatic rupture of the diaphragm. G Chir 1998; 19: 235–8.
Van de Ven K, Vanclooster P, de Gheldere C, Meersman A, Verhelst F. Strangulation: a late presentation of right-sided diaphragmatic rupture. Acta Chir Belg 1995; 95: 226–8.
Hoang AD, De Backer D, Bouazza F, Capello M, De Francquen P, Rocmans P. Undiagnosed rupture of right hemidiaphragm-hepatothorax: a case report. Acta Chir Belg 2002; 102: 353–5.
Rao G, Madoff HR. Bilateral rupture of the diaphragm with delayed strangulation. Chest 1989; 95: 244–5.
Sacco R, Quitadamo S, Rotolo N, Di Nuzzo D, Mucilli F. Traumatic diaphragmatic rupture: personal experience. Acta Biomed Ateneo Parmenese 2003; 74 Suppl 2: 71–3.
Karnikas ID, Dendrinos SS, Liakakos TD, Koufopoulos IP. Complications of congenital posterolateral diaphragmatic hernia in the adult. Report of two case and literatur review. J Cardiovasc Surg (Torino) 1994; 35: 555–8.
Akbar A, Parikh DH, Alton H, Clarke JR, Weller PH. Spontaneous rupture of the diaphragm. Arch Dis Child 1999; 81: 341–2.
Bisgaard C, Rodenberg JC, Lundgaard J. Spontaneous rupture of the diaphragm. Scan J Thorac Cardiovasc Surg 1985; 19: 177–80.
Dave KS, Bekassy SM, Wooler GH, Ionescu MI. »Spontaneous« rupture of the diaphragm during delivery. Br J Surg 1973; 60: 666–8.
Gupta V, Singhal R, Ansari MZ. Spontaneous rupture of the diaphragm. Eur J Emerg Med 2005; 12: 43–4.
Kierkegaard O, Sondergaard C, Rasmussen TP. Sponteneous rupture of the diaphragm in an obes woman. Eur J Surg 1993; 159: 377–8.
McIndoe GA, Hopkins NF. Spontaneous rupture of the diaphragm. Postgrad Med J 1986; 62: 389–91.
Ross DB, Stiles GE. Spontaneous rupture of the diaphragm in laboure: a case report. Can J Surg 1989; 32: 212–3.
Salomon J, Feller N, Levy MJ. A case of spontaneous rupture of the diaphragm. J Thorac Cardiovasc Surg 1969; 58: 221–4.
Stone AM, Pearson WT, Lansdow FS, Tice DA. Spontaneous rupture of the right diaphragm. Ann Thorac Surg 1970; 9: 479–82.
Mitchell TE, Ridley PD, Forrester-Wood CP. Spontaneous rupture of a congenital diaphragmatic eventration. Eur J Cardiothorac Surg 1994; 8: 281–2.
Kara E, Kaya Y, Zeybek R, Cosckun T, Yavuz C. A case of a diaphragmatic rupture complicated with lacerations of stomach and spleen caused by a violent cough presenting with mediastinal shift. Ann Acad Med Singapore 2004; 33: 649–50.
George L, Rehman SU, Khan FA. Diaphragmatic rupture: A complication of violent cough. Chest 2000; 117: 1200–1.
Kallay N, Crim L, Dungan DP, Kavanagh PV, Meredith W, Haponik EF. Massive left diaphragmatic separation and rupture due to coughing during an asthma exacerbation. South Med J 2000; 93: 729–31.
Heuckmann L, Kuster P, Schleef J, Uekotter J. Diaphragmatic rupture in perthussis. Monatsschr Kinderheilkd 1996; 144: 259–62.
Dutta T. Spontaneous rupture of diaphragm due to perthussis. J Pediatr Surg 1957; 10: 147–8.
Hill R, Heller MB. Diaphragmatic rupture complicating labour. Ann Emerg Med 1996; 27: 522–4.
Kurzel RB, Naunheim KS, Schwartz RA. Repair of symptomatic diaphragmatic hernia during pregnancy. Obstet Gynecol 1988; 71: 869–71.
Bekassy SM, Dave KS, Wooler GH, Ionescu MI. »Spontaneous« and traumatic rupture of the diaphragm: long therm results. Ann Surg 1973; 177: 320– 4.
El Nakadi B, Vanderhoeft P. Effort rupture of the diaphragm. Thorax 1990; 45: 715.
Newman BM, Afshani E, Karp MP, Jewett TC Jr, Cooney DR. Presentation of congenital diaphragmatic hernia past the neonatal period. Arch Surg 1986; 121: 813–6.
Sattler S, Canty TG, Mulligan MS, Wood DE, Scully JM, Vallieres E, et al. Chronic traumatic and congenital diaphragmatic hernias: presentation and surgical management. Can Respir J 2002; 9: 135.
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