Diaphragmatic Rupture Causing Repeated Vomiting in a Combined Abdominal and Head Injury Patient: a Case Report and Review of the Literature

Overview

Journal World J Emerg Surg

Publisher Biomed Central

Specialty General Surgery

Date 2012 Jul 4

PMID 22747741

Authors

Dimitrios Symeonidis

Michail Spyridakis

Georgios Koukoulis

Grigorios Christodoulidis

Ioannis Mamaloudis

Konstantinos Tepetes

Affiliations

Soon will be listed here.

Abstract

Background: Diaphragmatic rupture after blunt abdominal injury is a rare trauma condition. Delayed diagnosis is not uncommon especially in the emergency room setting. Associated injuries often shift diagnosis and treatment priorities towards other more life-threatening conditions.

Case Presentation: We present a challenging case of a young male with combined abdominal and head trauma. Repeated episodes of vomiting dominated on clinical presentation that in the presence of a deep scalp laceration and facial bruising shifted differential diagnosis towards a traumatic brain injury. However, a computed tomography scan of the brain ruled out any intracranial pathology. Finally, a more meticulous investigation with additional imaging studies confirmed the presence of diaphragmatic rupture that justified the clinical symptoms.

Conclusions: The combination of diaphragmatic rupture with head injury creates a challenging trauma scenario. Increased level of suspicion is essential in order to diagnose timely diaphragmatic rupture in multiple trauma patients.

References

Hanna W, Ferri L . Acute traumatic diaphragmatic injury. Thorac Surg Clin. 2010; 19(4):485-9. DOI: 10.1016/j.thorsurg.2009.07.008. View

Patselas T, Gallagher E . The diagnostic dilemma of diaphragm injury. Am Surg. 2002; 68(7):633-9. View

Balci A, Kazez A, Eren S, Ayan E, Ozalp K, Eren M . Blunt thoracic trauma in children: review of 137 cases. Eur J Cardiothorac Surg. 2004; 26(2):387-92. DOI: 10.1016/j.ejcts.2004.04.024. View

Chen J, Wilson S . Diaphragmatic injuries: recognition and management in sixty-two patients. Am Surg. 1991; 57(12):810-5. View

Turhan K, Makay O, Cakan A, Samancilar O, Firat O, Icoz G . Traumatic diaphragmatic rupture: look to see. Eur J Cardiothorac Surg. 2008; 33(6):1082-5. DOI: 10.1016/j.ejcts.2008.01.029. View

Reiff D, McGwin Jr G, Metzger J, Windham S, Doss M, Rue 3rd L . Identifying injuries and motor vehicle collision characteristics that together are suggestive of diaphragmatic rupture. J Trauma. 2002; 53(6):1139-45. DOI: 10.1097/00005373-200212000-00018. View

Lee W, Chen R, Fang J, Wang C, Chen H, Chen S . Rupture of the diaphragm after blunt trauma. Eur J Surg. 1994; 160(9):479-83. View

Shah R, Sabanathan S, Mearns A, Choudhury A . Traumatic rupture of diaphragm. Ann Thorac Surg. 1995; 60(5):1444-9. DOI: 10.1016/0003-4975(95)00629-Y. View

Sharma O . Traumatic diaphragmatic rupture: not an uncommon entity--personal experience with collective review of the 1980's. J Trauma. 1989; 29(5):678-82. View

10.

Simpson J, Lobo D, Shah A, Rowlands B . Traumatic diaphragmatic rupture: associated injuries and outcome. Ann R Coll Surg Engl. 2000; 82(2):97-100. PMC: 2503527. View

11.

Kuhn R, Schubert D, St Wolff , Marusch F, Lippert H, Pross M . Repair of diaphragmatic rupture by laparoscopic implantation of a polytetrafluoroethylene patch. Surg Endosc. 2002; 16(10):1495. DOI: 10.1007/s00464-001-4236-4. View

12.

Pfannschmidt J, Seiler H, Bottcher H, Karadiakos N, Heisterkamp B . [Diaphragmatic ruptures: diagnosis--therapy--results, experiences with 64 patients]. Aktuelle Traumatol. 1994; 24(2):48-51. View

13.

Matsevych O . Blunt diaphragmatic rupture: four year's experience. Hernia. 2007; 12(1):73-8. DOI: 10.1007/s10029-007-0283-7. View

14.

Guth A, Pachter H, Kim U . Pitfalls in the diagnosis of blunt diaphragmatic injury. Am J Surg. 1995; 170(1):5-9. DOI: 10.1016/s0002-9610(99)80242-6. View

15.

Nau T, Seitz H, Mousavi M, Vecsei V . The diagnostic dilemma of traumatic rupture of the diaphragm. Surg Endosc. 2001; 15(9):992-6. DOI: 10.1007/s004640090096. View

16.

Boulanger B, Milzman D, Rosati C, Rodriguez A . A comparison of right and left blunt traumatic diaphragmatic rupture. J Trauma. 1993; 35(2):255-60. DOI: 10.1097/00005373-199308000-00014. View

17.

Ilgenfritz F, Stewart D . Blunt trauma of the diaphragm: a 15-county, private hospital experience. Am Surg. 1992; 58(6):334-8; discussion 338-9. View

18.

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. PMC: 2689724. View