Abstract
Abstract
Background
Traumatic diaphragmatic hernias are frequently associated with multiple organ injuries caused by high-energy trauma. Herein, we report a case of left traumatic diaphragmatic hernia complicated by traumatic Stanford type B aortic dissection, in which we considered surgical strategies for the timing and approach of diaphragmatic hernia repair.
Case presentation
A 65-year-old man was transported to our hospital following a traffic accident. He was diagnosed with left traumatic diaphragmatic hernia, traumatic Stanford type B aortic dissection, multiple fractures of the left ribs, hemothorax, and pulmonary contusion. Because acute surgery for hernia repair might exacerbate aortic dissection, we initiated conservative treatment for aortic dissection. Respiratory status and ischemia of the herniated organs were monitored carefully. On the day 6, when the aortic dissection was considered stable, we performed diaphragmatic hernia repair. A large surgical field secured by thoracolaparotomy enabled safe surgical techniques for visualization of the aortic wall. Postoperatively, there was no diaphragmatic hernia recurrence, and the aortic dissection remained stable with conservative treatment.
Conclusions
In traumatic diaphragmatic hernia complicated by traumatic Stanford type B aortic dissection, elective surgery via the trans-thoracoabdominal approach may be safe after stabilization of aortic dissection, provided the respiratory condition can be kept stable.
Funder
Smoking Research Foundation
Publisher
Springer Science and Business Media LLC
Reference11 articles.
1. Clarke DL, Greatorex B, Oosthuizen GV, Muckart DJ. The spectrum of diaphragmatic injury in a busy metropolitan surgical service. Injury. 2009;40(9):932–7.
2. Shah R, Sabanathan S, Mearns AJ, Choudhury AK. Traumatic rupture of diaphragm. Ann Thorac Surg. 1995;60(5):1444–9.
3. Bergeron E, Clas D, Ratte S, et al. Impact of deferred treatment of blunt diaphragmatic rupture: a 15-year experience in six trauma centers in Quebec. J Trauma. 2002;52(4):633–40.
4. Chughtai T, Ali S, Sharkey P, Lins M, Rizoli S. Update on managing diaphragmatic rupture in blunt trauma: a review of 208 consecutive cases. Can J Surg. 2009;52(3):177–81.
5. Vignon P, Boncoeur MP, François B, Rambaud G, Maubon A, Gastinne H. Comparison of multiplane transesophageal echocardiography and contrast-enhanced helical CT in the diagnosis of blunt traumatic cardiovascular injuries. Anesthesiology. 2001;94(4):615–22.