Transthoracic Littre's hernia presenting with faecopneumothorax following perforation of the Meckel's diverticulum: a late complication of oesophagectomy.

A Littre's hernia is an unusual phenomenon where a Meckel's diverticulum protrudes through a potential abdominal opening. We wish to present a unique case of a 79-year-old man with respiratory distress following a fall from standing, initially managed as a haemothorax. After a chest drain was placed, bowel contents were drained from the pleural cavity and he was taken to theatre. He had a history of minimally invasive oesophagectomy for cancer and had subsequently developed a diaphragmatic hernia. A blind ending diverticulum with a perforation at its tip was found in the left oblique lung fissure that was subsequently confirmed histologically as a perforated Meckel's diverticulum. The patient had a prolonged stay on the intensive care unit with a left-sided empyema that was managed radiologically prior to discharge. Unfortunately 4 months postoperatively, he passed away from hospital-acquired pneumonia on a rehabilitation ward.

Traumatic displacement of stomach - a case report.

These days we have fast paced traffic on our roads to help us keep up with our fast paced life. But every boon has a down side and our high velocity traffic is no exception. Here is a case report of a blunt abdominal injury following a road traffic accident. Externally the deceased had only a few grazed abrasions on the forehead and right forearm. But on internal examination of abdomen, it was noticed that the left hemi-diaphragm was torn and the stomach and intestines were found displaced into the left thoracic cavity.

An unusual autopsy case of incomplete decapitation of a motorcyclist with herniation of thoracic organs through a helmet-related neck wound.

The authors report an unusual autopsy case of a motorcyclist who wore a full-face type helmet and had incomplete decapitation and herniation of the heart and a portion of the right lung through an extensive lacerate wound on the front of the neck after his motorcycle crashed. The authors identified 2 main offensive dynamics that occurred simultaneously: First, partial decapitation with a extensive gaping wound on the neck caused by the chin strap after a violent angular movement of the head; second, the translocation of the abdominal organs into the thorax and the herniation of the thoracic organs through the neck wound generated by a compressive trauma of the thorax and abdomen. This singular case, like few others in forensic literature, shows the possibility of helmet chin strap-related traumas and highlights the limitations of modern protective helmets. If the postulated mechanism is confirmed despite the massive benefits derived from the compulsory use of protective helmets, the properties of the helmet chin strap would need to be reassessed to improve the protection of the soft tissue and bones in the neck.

Traumatic diaphragmatic hernia in a 5-month-old boxer dog.

A 5-month-old intact male boxer dog was presented to the Metro Animal Emergency Clinic, Dartmouth, Nova Scotia after being hit by a car. Radiography identified a diaphragmatic hernia with the stomach herniated into the thoracic cavity. Diaphragmatic herniorrhaphy and splenectomy were performed without complication. The patient returned to his regular active lifestyle.

Hernie diaphragmatique traumatique chez un chien Boxer âgé de 5 mois. Un chien Boxer mâle intact âgé de 5 mois a été présenté à la clinique Metro Animal Emergency Clinic à Dartmouth, en Nouvelle-Écosse, après avoir été heurté par une automobile. La radiographie a identifié une hernie diaphragmatique avec l'estomac hernié dans la cavité thoracique. Une hernioplastie diaphragmatique et une splénectomie ont été réalisées sans complications. Le patient est retourné à son style de vie actif régulier.(Traduit par Isabelle Vallières).

[Treatment of giant diaphragmatic hernia].

The authors demonstrate the results of treatment (16 patients) with giant paraesophageal and posttraumatic diaphragmatic hernia. The article represents the main principles of operation management, key moments of the choice of access, operative techniques and also the features of the usage of modern reticular implants.

Delayed enterothorax and hepatothorax due to missed right-sided traumatic diaphragmatic rupture.

Traumatic diaphragma ruptures (DRs) are an unusual condition after blunt thoracoabdominal trauma, and there are some difficulties in the diagnosis, in the absence of the additional life-threatening injuries. Right-sided injuries are less frequent than left-sided injuries and may be missed easily. Intrathoracic herniation of abdominal organs is an uncommon condition for right-sided DR. Particularly, to our knowledge, progressive hepatothorax and enterothorax that develop over years are a very rare presentation of DR. Herein, we present a case of progressive thoracic herniation of the abdominal organs, diagnosed 22 years after the initial trauma.

Sudden death following delayed traumatic diaphragmatic herniation.

Blunt force trauma to the chest can often result in diaphragmatic tears. These tears can go months without being discovered, until a secondary injury or circumstance causes an organ to herniate through the diaphragm. Special care should be taken at autopsy to determine the mechanism of injury of any tears in the diaphragm as this may influence the cause and manner of death. We present a case of a 28-year-old man who suffered multiple injuries in a motor vehicle collision. Six months later he presented with a left diaphragmatic tear and gastric fundal herniation, and died eventually.

[Acute abdomen several years after accident due to traumatic diaphragmatic hernia]. / Acut hasi katasztrófát okozó, kizáródott, traumás eredetû rekeszsérv több évvel a balesetet követôen.

The complicated diaphragmatic hernia of traumatic origin, is a life-threatening condition. In most cases, the diaphragmatic rupture is caused by blunt trauma that affects the chest or abdomen, but penetrating wounds may represent also an etiological factor. Traffic accidents are primarily involved, in time of peace. We report a case of a 59-year-old male patient, who had a traffic accident 16 years before his admission to the emergency department. In these years he produced vague dyspeptic symptoms and was treated several times for pleural effusions and COPD. At the time of his latest admission he had frank signs of an acute abdomen.

Traumatic diaphragmatic hernia masquerading as left-sided hydropneumothorax: a case report.

Traumatic diaphragmatic rupture (TDR) is rare in children and can be easily overlooked because of lack of awareness of late presentation and concomitant injuries. A 4-year-old girl presented with respiratory distress 2 months after a road traffic accident. The initial differential diagnosis was pneumonia or pulmonary tuberculosis with associated pleural effusion. On further assessment, a diaphragmatic hernia was suspected. The initial radiograph showed left hydropneumothorax. Fluoroscopy, follow-up chest radiographs and barium swallow confirmed the diagnosis of left TDR. Surgery was undertaken but unfortunately she did not survive. Awareness of delayed presentation of TDR is essential for prompt management.

Factors influencing mortality in traumatic ruptures of diaphragm.

BACKGROUND: Diaphragmatic injuries are infrequent but severe injuries, associated with high morbidity and mortality. METHODS: The hospital records of 58 patients with traumatic rupture of diaphragm which was diagnosed during surgery in emergency department during last five years were re-evaluated, in order to identify the factors on mortality. RESULTS: The mean age of patients was 33 years. The most common cause of diaphragmatic rupture was penetrating injury (52%). The overall mortality rate was 21%. Preoperative diagnoses were accurately made in only twelve (20%) patients and remaining 46 patients were diagnosed during surgery. Rupture was located on the left side in 42 patients. Intrathoracic herniation was seen in eleven cases. Presence of herniation has no effect on mortality (p=0.155). All cases with mortal course were blunt trauma and the most common cause of death was haemorrhagic shock. Associated injuries were present in 88% of the patients; 92% of the mortal cases had an associated injury. CONCLUSION: The diagnosis of diaphragmatic injury is important due to increased morbidity and mortality in traumatic victims. Blunt trauma, increased grade of injury, presence of shock, blood transfusions over three units and splenic injury are factors influencing mortality in traumatic ruptures of diaphragm.

Traumatic intercostal pulmonary herniation: a case report.

We report a case of intercostal pulmonary hernia through a defect in the wall of the thoracic cavity which occurred after blunt thoracic trauma. Diagnosis of pulmonary herniation was confirmed radiologically by chest X-ray and computed tomographic scan. After initial inspection by video-assisted thoracoscopy which also revealed a diaphragmatic rupture, a postero-lateral thoracotomy was performed. The defect of the thoracic wall was repaired with two reconstruction plates. The hernia was successfully repaired with prosthetic mesh. Review of the literature shows that when required, surgical repair of pulmonary herniation is the treatment of choice.

Combined diaphragmatic and urinary bladder rupture after minor motorcycle accident (report of a case and literature review).

Diaphragmatic and urinary bladder ruptures are rare entities after blunt abdominal trauma and they are usually the results of high energy injuries. They seldom occur in isolation. For the diaphragmatic rupture, the accurate diagnosis depends on high index of suspicion and careful scrutiny of the chest X-ray, while gross hematuria is the hallmark finding in patients with bladder rupture. Suprapubic pain, tenderness, and inability to void are the main symptoms and signs of bladder rupture. In this report, we describe our successful experience with a case of combined diaphragmatic and urinary bladder rupture occurred in isolation as a result of low energy trauma, with special emphasis on diagnosis and surgical treatment.

Diaphragmatic laceration, partial liver herniation and catamenial pneumothorax.

Catamenial pneumothorax is a recurrent pneumothorax temporally associated with menstruation. Pathogenesis remains debated however pleural endometriosis or diaphragmatic abnormalities are almost always present. We report the case of a 35-year-old woman with recurrent right catamenial pneumothorax. At thoracoscopy a large laceration of the diaphragm with partial intrathoracic liver herniation was seen. Treatment involved repair of the diaphragmatic lacerations, and pleurodesis. This report shows that large diaphragmatic defects may be observed in patients with catamenial pneumothorax.

Late complication of diaphragmatic gunshot injury: appendix perforation due to colon incarceration.

Missing the diaphragmatic injury on first admission is often associated with late complications. A 38 year-old male patient is presented here as a case of missed diaphragmatic injury due to gunshot injury resulted with fecal peritonitis. Celiotomy revealed a distended appendix perforation due to herniated left colon obstruction through the left pleural cavity. Left colon and stomach were reduced to peritoneal cavity and diaphragm was repaired with interrupted polypropylene sutures. After being sure about the viability of the colon and stomach, appendectomy with cecal exteriorization was performed. Postoperative period was uneventful. The patient was discharged on the 10th postoperative day. A thorough inspection of the diaphragm is essential in thoraco-abdominal trauma. Repair of the diaphragmatic defects should invariably carried out to avoid life-threatening complications.

[Tension faecopneumothorax as the rare presenting feature of a traumatic diaphragmatic hernia]. / Une complication rare des hernies diaphragmatiques traumatiques: la pleurésie stercorale.

A traumatic diaphragmatic hernia is a well-known complication following abdominal trauma. It occurs in approximately 3% of abdominal injuries with a 2/1 ratio of penetrating trauma. These injuries remain undiagnosed in nearly half of the patients in the acute phase. Hence, delayed presentation, days or even years after the onset of the initial trauma, are not uncommon. Indeed, they are often revealed by a complication. It's exactly what happened with our patient who presented with an acute tension fecopneumothorax, resulting from diaphragmatic herniation and perforation of the colon in the pleural cavity. This presentation is rarely reported. In a search of the literature, only 11 cases could be found.

[Diaphragmatic rupture in abdominal trauma]. / Karin Travmasinda Diyfragma Rüptürü.

BACKGROUND: The aim of the study is to evaluate the patients with diaphragmatic rupture due to penetrating or blunt abdominal trauma. METHODS: Thirty-eight patients with diaphragmatic rupture due to penetrating or blunt abdominal trauma were investigated retrospectively. RESULTS: The average age was 41,72 and there were 31 male and seven female patients. The injury forms were penetrating trauma in 22 (58%) and blunt trauma in 16 (42%) cases. Associated abdominal organ injuries were found in 27 (71%) cases. Among 47 diaphragmatic ruptures, 27 (57%) were on the left and 20 (43%) were on the right side. The average diameter of the rupture was 5,45 (1-20) cm. Management of the diaphragmatic rupture and other associated organ injuries were accomplished through laparotomy. Morbidity was developed in 18 cases and mortality in four cases with associated abdominal organ injuries. CONCLUSION: Diaphragmatic rupture results in high morbidity and mortality due to associated organ injuries.

[Traumatic intrathoracic herniation of the left kidney]. / Herniación intratorácica traumática del riñón izquierdo.

The detection of a intrathoracic kidney is an exceptional discovery. There is a large period of time between the injury and its clinical presentation revising the literature, so it is possible that the herniation of the kidney into the chest was caused by a rise in intra-abdominal pressure but going through a preexistent congenital way not caused by the traumatism. In order to dismiss this possibility and to prove the traumatic origin of the diaphragmatic rupture, surgeons have examined the intraoperative characteristics of the rupture's borders. The elevation of the kidney has been said to be progressive because of the positive intra-thoracic pressure and the negative intra-abdominal one. Our objective is to report an extraordinary case of abdominal traumatism whose clinic and radiological proofs let us get a rapid diagnosis and surgical demonstration of the direct herniation of the left kidney into the chest through a diaphragmatic rupture caused by the same traumatism.