Intra-abdominal injury identified by CTA in stable blunt polytrauma patients

Background: Patients with multiple injuries are a challenge to evaluate and to exclude abdominal injury, especially those who are intubated and sedated. Ultrasound is a screening tool and peritoneal lavage is unreliable. The aim of the study was to determine the incidence of intra-abdominal injury and describe the subsequent management after CT "panscan" in patients sustaining blunt trauma with injuries both above the thoracic and below the pelvic diaphragm. Methods: In a retrospective analysis anonymised patient data were extracted from a prospective ethics approved database of patients admitted to the level I Trauma Unit at Inkosi Albert Luthuli Central Hospital for the period from April 2007 to March 2011. Blunt polytrauma patients, aged 2 years and older with injuries above the diaphragm and below the pelvic floor were included, provided they were investigated by a full-body trauma Computed Tomography contrast study. Descriptive statistics were employed for all variables of interest, with counts/frequencies and associated percentages being reported. Results: Of 284 patients with injuries above the thoracic and below the pelvic diaphragm, 87 (30.6%) had intra-abdominal injury and 197 (69.4%) had no intra-abdominal injuries. Of those 87 patients, 54 (62.1%) were treated non-operatively and 33 (37.9%) were treated surgically with regard to their abdominal injuries. Twenty (22.9%) patients died, 4 due to intra-abdominal injuries and 16 due to of extra-abdominal injuries. Nine (45%) of the twenty patients who died were treated operatively for intra-abdominal injuries and the remaining 11 (55%) were treated non-operatively.Conclusion: Around thirty percent of patients with injuries above the thoracic and below the pelvic diaphragm had concomitant intra-abdominal injuries. Of those with abdominal injury, just over half required laparotomy. For haemodynamically stable patients CT scanning identified those who require surgical intervention and those who may be managed non-operatively, therefore liberal CT-scanning is advisable for this patient group

Potential for revitalisation of the diaphragm for family planning in Uganda: a rapid assessment of the feasibility of introducing the SILCS Diaphragm

This health systems assessment evaluated the feasibility of introducing a new contraceptive device, the SILCS single-size diaphragm, into the existing family planning method mix in Uganda. A total of 26 focus group discussions with 201 female and 77 male potential users and 98 key informant interviews with policymakers and providers were conducted between June and August 2010. Potential users, providers, and policymakers recognised that the SILCS Diaphragm could fill a gap in the method mix and expressed eagerness to make the SILCS Diaphragm available, particularly because it is nonhormonal and woman initiated. The diaphragm was viewed by all stakeholders as a method that would increase choice and could improve women's reproductive health in Uganda. Like many countries, Uganda's family planning programme is financially stretched, and clear support for the SILCS Diaphragm by end-users will need to be demonstrated before the product will be considered for public-sector introduction. Afr J Reprod Health 2014; 18[2]: 77-86)

Laparoscopic Repair of Penetrating Injury of the Diaphragm: an Experience from a District Hospital

In this study we review our experience in using laparoscopy as a diagnostic and therapeutic tool in dealing with penetrating diaphragmatic injuries due to stab wounds and look at the feasibility of using this procedure in other similar institutions. Thirty patients; all of whom were males 20-30 years of age; presented to the surgical emergency unit of our hospital with upper abdominal and lower chest wall stab wounds between 01-05-1998 and 30-11-2006. Diagnosis of the diaphragm injury was either obvious with omentum herniating through the chest wall; or occult with confirmation of the injury at laparoscopy. All patients underwent diagnostic laparoscopy; which resulted in identification and efficient treatment of eight patients with diaphragmatic injury; and thereby laparotomy was avoided. The procedure converted to open surgery in one patient because of a small left-sided colonic tear. Laparoscopy is an efficient tool for the diagnosis and management of diaphragmatic injuries. It should be used routinely instead of exploratory laparotomy in haemodynamically stable patients with penetrating lower chest injuries

Right-Sided Recurring Catamenial Pneumothorax Complicated by a Diaphragmatic Hernia

No diaphragmatic hernia was reported with a catamenial pneumothorax. We report herein a case of right-sided recurring catamenial pneumothorax complicated by a latent diaphragmatic hernia

Traumatic ruptured diaphragm: a clinical diagnostic dilemma

Sequel to a car crash; Chief A; a 52-year old bankerpresented in the Orthopaedic Unit of University of Nigeria Teaching Hospital Enugu with fracture right forearm bones and minor bruises in the abdomen and buttocks. His fractured right forearm was treated surgically and patient was dischharged. A month later; Chief A developed breathlessness and was therefore re-admitted in same hospital where radiological survey including plain chest radiography and tailored barium meal revealed a hitherto clinically Occult rupture left hemi-diaphragm with mediastimal shift to the contra-lateral side. We present this case to highlight the pleomophism of traumatic rupture of diaphragm with emphasis on the causes; clinical presentation; complications and model of progression and different treatment options

Rupture diaphragmatique gauche dans le service de chirurgie A de l'hôpital national du Point G: étude de deux cas

A l'occasion de 2 observations de rupture diaphragmatique gauche avec éviscération de plusieurs viscères abdominaux dans le thorax; nous nous proposons de rappeler quelques points importants du diagnostic et traitement de ces lésions traumatiques rares du diaphragme. En 31 mois (janvier 1993 - juillet 1995) nous avons recense dans notre service 2 cas de rupture diaphragmatique gauche. Il s'agit de 2 hommes; le premier a 38 ans et le second a 20 ans; tous victimes d'un accident de la circulation. Le premier a été reçu en urgence dans le cadre de polytraumatisme; le second a froid 2 mois après son accident pour des manifestations cliniques thoraco-abdominales gauches. Le traitement chirurgical a consisté après la réduction de l'éviscération à faire un parage et une suture des piliers et des legs du diaphragme; ainsi qu'un mécanisme anti reflux selon Nissen. Les suites opératoires ont été simples dans l'ensemble les ruptures diaphragmatiques sont rares et ne rencontrent que dans 1 a 2 pour cent des traumatismes thoraciques fermes graves. Elles peuvent également se voir dans les traumatismes ou prédomine un impact abdominal. Les lésions gauches sont habituellement plus fréquentes. Le diagnostic de rupture diaphragmatique gauche est souvent difficile et pour plusieurs raisons: la lésion se situe habituellement dans un contexte de polytraumatisme qui peut la masquer; la symptomatologie est parfois retardée de plusieurs heures ou jours; enfin certaines ruptures restent muettes pendant des mois voire des années et ne manifestent que tardivement par une complication de l'éviscération viscérale abdominale dans le thorax. Nos résultats sont comparables à ceux des auteurs africains et européens