Does a negative emergency celiotomy exclude the possibility of significant diaphragmatic Injury? a case report and review of the literature

Alireza Hamidian Jahromi, David Pennywell, John T Owings

Research output: Contribution to journalReview article

3 Scopus citations

Abstract

Introduction: Diaphragmatic rupture (DR) is an uncommon, potentially serious complication following blunt or penetrating abdomina trauma. Even with a high index of suspicion, the diagnosis of DR can easily be missed for a long period post injury. Delaye or missed diagnosis [delayed diagnosis of diaphragmatic rupture (DDDR)] and delayed diaphragmatic rupture (DDR) are possibl explanations in cases where the initial operative exploration fails to show the diaphragmatic damage Case Presentation: Here we present a patient with suspected DR that was not seen on initial open abdominal exploration, bu was suggested by subsequent serial imaging. This injury was ultimately identified on laparoscopic exploration. The procedure wa converted to open (celiotomy) due to poor tolerance of the pneumoperitoneum required for laparoscopy, and the laceration wa primarily repaired. We propose that DDR and DDDR be considered as a differential diagnosis in patients with a previous thoracoabdomina trauma when presenting with radiologic/clinical signs suspicious for DR, even when the immediate post traumatic exploratio failed to demonstrate a DR Conclusions: A high index of suspicion is essential for early detection of DDR and DDDR. Patients with high impact injuries o surrounding organ damage should be followed with serial clinical examinations, follow-up radiologic assessments, and even reexploratio in situations highly suspicious for diaphragmatic injuries.

Original languageEnglish (US)
Article numbere25053
JournalTrauma Monthly
Volume21
Issue number4
DOIs
StatePublished - Sep 1 2016
Externally publishedYes

Keywords

  • Celiotomy
  • Celiotomy
  • Complications
  • CT Scan
  • Delayed Diaphragmatic Rupture
  • Diaphragm
  • Imaging, Multidetector Computed Tomography
  • MDCT

ASJC Scopus subject areas

  • Medicine(all)

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