Hernias diafragmáticas traumáticas

  1. Heras Gómez, Félix
  2. Cilleruelo Ramos, Ángel
  3. Loucel Bellino, Mauricio
  4. García Rico, Cristina Beatriz
  5. Arévalo Pardal, A. M.
  6. Gregorio Crespo, Begoña
  7. Matilla González, José María
  8. García Yuste, Mariano
Journal:
Anales de la Real Academia de Medicina y Cirugía de Valladolid

ISSN: 0210-6523

Year of publication: 2013

Issue: 50

Pages: 55-69

Type: Article

More publications in: Anales de la Real Academia de Medicina y Cirugía de Valladolid

Abstract

The diafragm is a thin and flat musculo-fascial structure that separates the chest from the abdominal cavity. Traumatic diaphragmatic hernia is an infrequent and life-threatening injury that may happen in patients with severe blunt or penetrating thoracoabdominal trauma. Diaphragmatic rupture is an important indicator of the severity of the trauma. These ruptures may be recognized at the time of the initial trauma, but are diagnosed months or even years later during the follow-up for related symptoms. If it is not detected early, the mortality rate could increase due to severe complications. The diagnosis of traumatic diaphragmatic hernia is difficult and often missed, because it could be accompanied by injuries to other organs. Supine chest radiography, despite its known limitations, is the initial most commonly performed imaging test to evaluate a traumatic injury in the thorax. However, computed tomography (CT) is the imaging tool of choice, as it is the key element for the detection of diaphragmatic injury after trauma. In hemodynamically stable patients, either videolaparoscopy or videothoracoscopy are recommended for the diagnosis and repair of a missed diaphragmatic injury. The surgical repair with nonabsorbable simple sutures is adequate in most cases, and the use of mesh should be reserved for chronic and large defects.