Imaging Diagnosis And Surgical Treatment Of Traumatic Diaphragmatic Hernia

Traumatic diaphragmatic hernia is often associated with multiple and complex injury of other parts or organs, the clinical manifestation is complex, which easily resulting in misdiagnosis and missed diagnosis. And then Influence the treatment and outcome. In some cases serious consequences will occur, even cause the death. The clinical morbidity of Traumatic diaphragmatic hernia is low, and related reports in china is not much. Clinical datathis paper observes the clinic data of30traumatic diaphragmatic hernia patients admitted to our hospital from1983, in which there are male23, female7cases, aged from12to78year, the cause of injury include11traffic accidents,2fall injuries,3stab wounds,7latrogenic injuries.23definite preoperative diagnosis with7operation diagnosis.24left diaphragmatic hernia and6right diaphragmatic hernia, no bilateral diaphragmatic hernia.4cases are associated with hemorrhagic shock,6cases with rib fracture,2cases with hemopneumothorax,3cases with pulmonary contusion,11cases with hepatic or spleenic rupture,11cases with gastrointestinal rupture,9cases with bone fracture,3cases with brain injury. The herniated organs include the greater omentum, colon, stomach, spleen, small intestine and liver, the width of diaphragm rupture is3—25cm. There are8cases in abdominal operation,17cases in thoracic operation,2cases in both abdominal and thoracic operation.26cases were cured,1cases died from postoperative respiratory failure. The reasons causeing traumatic diaphragmatic hernia include penetrating trauma such as sharps, bullet injury, experience violent collision, compression, take the force too much, damage to diaphragm in closed thoracic drainage, repair the diaphragm rupture without tiedness, or the line nodes fall off, the channel for the stomach tube is too big. DiscussTraumatic diaphragmatic hernia is often associated with multiple and complex injury of other parts or organs, the chest upright flat sheet often act as the primary examination, but when the chest radiographs showed fuzzy while suspecting the gastrointestinal tract hernia into the pleural cavity, we should choose the gastrointestinal contrast examination. CT imaging is clear to the diaphragmatic injury, especially for the smaller one, should be used as the preferred check. MR could distinguish the Intestine, liver with tissue in thoracic cavity very well, The imaging is similar to CT. B ultrasound is particularly applicable to the seriously disabled patients. The suspected traumatic diaphragmatic hernia patients who is in stable condition could be given vertical radiography examination after artificial pneumoperitoneum. If patients feel more dyspnea after peritoneal lavage, and the perfusion fluid come out from the closed thoracic drainage tube, the diagnosis of diaphragmatic rupture can be given. But if there is only little or none perfusion fluid come out, Or some bile, urine, food residue and bacterias colonizating in colonic tract such as Escherichia coli, consideration should also be given to the diaphragmatic rupture. Once after the traumatic diaphragmatic hernia diagnosis is reached, immediately, checking the status of chest, abdominal injury, operation treatments should be given as earlier as possible according to the principle of "priority to serior one, simple and effective". Operation exploration should be careful, bilateral diaphragmatic should be explorated in abdominal operation. Be not satisfied with only one discovery. Patients, who is after operation through the diaphragm, feel chest tightness, difficulty breathing, consideration should be given to diaphragmatic hernia, the early diagnosis and treatment should be given as fai as possible.