Report of Rare Emergency Presentations and Management of Delay Diaphragmatic Hernia in Five Cases

Amir Hassankhani, Alireza Amir Maafi, Yasman Safarpoor, Manouchehr Aghajanzadeh, Mohammad Sadegh Esmaeili Delshad, Tina Mehrpey Moghaddam and Elahe Rafiei

Guilan University of Medical Sciences, Rasht, Iran
Department of Internal Medicine, Inflammatory Lung Disease Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran

^*Correspondance to: Amir Hassankhani 

 PDF  Full Text DOI: 10.25107/2474-1647.1480

Abstract

Diaphragmatic Ruptures (DR) is a life-threatening condition. (DR) are quite uncommon and often result from either blunt or penetrating trauma. (DR) are usually associated with abdominal trauma however, it can occur in isolation. Acute traumatic rupture of the diaphragm may go unnoticed and there is often a delay between the injury and the diagnosis. Tension Gastro Thorax (GT), Colo Thorax (CT) and Hepato Thorax (HT) is a life-threatening condition and presents dramatically with acute and severe respiratory distress. It develops when an intrathoracic herniation of stomach, liver or colon through a diaphragmatic defect. Massively distended stomach and colon by trapped air or fluid causing mediastinal displacement. Tension GT, CT and HT is often missed as tension pneumothorax and managed as such leading to increased morbidity and mortality. Immediate clinical and radiographic evaluation should lead to accurate diagnosis followed by emergency decompression of the stomach, colon and liver. Reduction of herniated viscera must be done before laparotomy and repair of the diaphragmatic defect. We present five cases with tension (GT), (CT) and (HT). We performed transthoracic decompress of stomach and colon in three case with chest tube insertion because other methods were not successful for decompressions and emergency laparotomy. In two cases right side emergency thoracotomy was performed. Because of this unusual condition, tension (GT), (CT) and (HT) has not been well characterized in traumatic diaphragmatic hernia in the literature reviews.

Keywords

Tension gastrothorax; Colothorax; Hepatothorax; Laparotomy; thoracotomy; Diaphragmatic hernia

Cite the article

Hassankhani A, Maafi AA, Safarpoor Y, Aghajanzadeh M, Delshad MSE, Moghaddam TM, et al. Report of Rare Emergency Presentations and Management of Delay Diaphragmatic Hernia in Five Cases. Clin Surg. 2017; 2: 1480.