1/5. Laparoscopic repair of a ruptured diaphragm secondary to blunt trauma.The diagnosis of acute diaphragmatic rupture can be a challenge for even the most experienced clinician. The treatment of the rupture and its concomitant injuries, particularly in the elderly, can be associated with significant morbidity and mortality. The advent of laparoscopy for both the diagnosis and repair of this condition has allowed a more minimally invasive approach. We present the case of a 70-year-old woman who was hurt in a motor vehicle crash. On admission, her physical exam showed left upper quadrant tenderness and bruising. The chest radiograph was suggestive of a ruptured diaphragm. She was taken to the operating room and explored laparoscopically. After a thorough exploration of all the abdominal contents, a tear in the diaphragmatic hiatus to the right of the esophagus was noted. The stomach and small intestine were returned to the abdomen, and the diaphragmatic rupture was repaired. We conclude that laparoscopic exploration and repair of a ruptured diaphragm in a bluntly injured patient is a safe and effective option in selected cases.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/5. Delayed traumatic diaphragmatic hernias presenting with strangulation.Traumatic diaphragmatic injuries commonly occur following blunt and penetrating trauma, and that may be missed during a first evaluation, resulting in chronic diaphragmatic hernia and/or strangulation. In this study, we present three cases of delayed traumatic diaphragmatic hernias presenting with strangulation. The type of trauma was blunt in two and penetrating in one patient. In all three cases, the diagnoses of diaphragmatic injuries were missed in acute and chronic settings. While two patients had transverse colonic strangulation, the other one had strangulated stomach and spleen. Transverse colon resection was performed in one patient. Two patients had postoperative complications, and no postoperative mortality was detected. patients complaining of upper abdominal pain and dyspnea with past history of thoracoabdominal trauma should be evaluated for a missed diaphragmatic injury. A high index of suspicion, physical examination of the chest, and x-ray film are helpful for diagnosis of delayed traumatic diaphragmatic hernias presenting with strangulation.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/5. Traumatic rupture of the pericardium.patients with traumatic rupture of the pericardium rarely survive to reach a hospital. Ten cases from the maryland Institute for emergency medical services Systems and 132 previously published cases are reviewed. patients were usually men who were victims of violent thoracic trauma. The median age was 40 years. Half of the patients had left pleuropericardial tears; tears of the diaphragmatic pericardium, right pleuropericardium, and superior mediastinal pericardium were less frequent. Associated injuries of the heart or left hemidiaphragm were common. Pericardial rupture was usually discovered during surgical exploration for other indications, but physical or radiographic signs were occasionally present. Repair is indicated for most pericardial tears to prevent herniation of the heart or abdominal viscera.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/5. Traumatic diaphragmatic hernia presenting as an intercostal hernia: case report.Intercostal hernias are rarely reported in the literature. We report a case of intercostal hernia secondary to a ruptured right hemidiaphragm and fractured costal margin caused by blunt trauma. The patient was ventilated at initial hospitalization because of rib fractures and advanced age, and the intercostal hernia was not evident. After physical rehabilitation treatment elsewhere, a painful chest wall bulge developed. A chest film and computed tomographic scan revealed the hernia. Surgery with a thoraco-abdominal incision in the line of the hernia allowed reduction of the hernial contents.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/5. Non-iatrogenic perforation of the stomach by a chest tube in a patient with traumatic diaphragmatic hernia.A 40-year-old Libyan male was admitted to the intensive therapy unit of Zliten Central Hospital, libya after a road traffic accident in which he had been the driver. On physical examination he was irritable, dyspnoeic, cyanotic, had contusions and abrasions on his chest and abdomen (mainly on the left side), a lacerated wound on the forehead, a large haematoma over the left thigh and tenderness over the left side of the chest and abdomen.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |