Alexandra Argiroff, MD, Dahlia Kenawy, BSE, John-Paul Bellistri, MD, Diego R Camacho, MD. Montefiore Medical Center
Introduction: Traumatic diaphragmatic injuries (TDIs) represent 0.46 percent of traumas reported in the National Trauma Data Bank in 2012, two-thirds of which are a result of penetrating trauma.[1] Both penetrating and blunt trauma more commonly create left-sided TDIs, while penetrating injuries in particular are more likely to be missed.[2] Evidence-based guidelines for appropriate repair of chronic traumatic diaphragmatic hernias have yet to be elucidated. However, the transthoracic approach is usually recommended to avoid chronic intra-peritoneal adhesions.
Case Description: We present the case of a 52-year-old man status post exploratory laparotomy and splenectomy 30 years ago following a stab wound who presented with left-sided abdominal pain and shortness of breath for several years. He was subsequently discovered to have a grade V traumatic diaphragmatic hernia containing splenic flexure of colon and tail of pancreas. The patient underwent laparoscopic repair of the hernia. All contents of the hernia sac were completely reduced and the defect was repaired primarily with mesh underlay.
Discussion: Laparoscopy provides a safe and effective method for reduction and repair of chronic diaphragmatic hernias. Mesh is a useful adjunct to the repair of chronic hernias as the diaphram is often atrophied or unable to be approximated.
References:
[1]. Fair KA, Gordon NT, Barbosa RR, et al. Traumatic diaphragmatic injury in the American College of Surgeons National Trauma Data Bank: a new examination of a rare diagnosis. Am J Surg 2015; 209:864.
[2]. Feliciano DV, Cruse PA, Mattox KL, et al. Delayed diagnosis of injuries to the diaphragm after penetrating wounds. J Trauma 1988; 28:1135.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87534
Program Number: V262
Presentation Session: Friday Video Loop (Non CME)
Presentation Type: VideoLoop
sages_adbutler_leaderboard