Traumatic Diaphragmatic Rupture – A Clinical Experience

Introduction: Traumatic diaphragmatic injuries arepotentially life-threatening due to herniation of abdominalorgans into the pleural cavities. They can be easily overlookedon initial diagnostics and a high index of suspicion is required.Aim: To analyse the various traumatic diaphragmatic hernias.Material and methods: A clinical study to analyse 50 patientsin our experience with patients suffering from traumaticdiaphragmatic rupture.Results: 18-50 yrs of age group is the most affected age groupwith diaphragmatic hernias, gender wise males with bluntinjuries are more in study. Right sided is the more affectedside. The cause of diaphragmatic rupture was blunt injuriesin 23 cases and penetrating injury in 5 cases. 3 patients withacute presentation had uneventful recovery, 2 patients had bileperitonitis and one died. In the cases with late presentation, allpatients had uneventful recovery but for 9 patients who hadintestinal obstruction. On the 6th.post-op day, one patient with–acute intestinal obstruction and sepsis, died.Conclusions: Morbidity and mortality of diaphragmaticruptures are mainly determined by associated injuries orcomplications of diaphragmatic herniation like incarcerationof viscera or lung failure. Early diagnosis helps to preventsevere complications. Laparotomy is an adequate surgicalapproach for diaphragmatic repair.

Surgical Repair of Scimitar Syndrome

Scimitar syndrome (SS) is a form of partial anomalous pulmonary venous drainage that is dramatically visible on plain chest radiography (CXR). In these individuals, the entire venous drainage from the right lung enters a single anomalous large vein that descends to the inferior vena cava. This descending vein is visible on CXR as a curvilinear density along the right heart border and resembles the curved Turkish sword that gives the condition its name. SS forms part of the large spectrum of associated conditions known as venolobar syndrome. These include right lung hypoplasia or sequestered segments of right lung, congenital heart disease and various others. We report, along with our other five cases, a special case of a young woman who presented incidentally, with a murmur, at 16 years of age. Full investigation including angiography showed a large atrial septal defect (ASD) with right heart dilation and SS. She underwent surgical correction with uneventful and complete correction by baffling of the scimitar vein from its entry into the inferior vena to the left atrium through the enlarged ASD.