A Case Report on Diaphragmatic Rupture, in the Visceral Surgery of Hospital of Conakry, Guinea
Journal of Surgery
Volume 4, Issue 3, June 2016, Pages: 76-80
Received: Jun. 5, 2016;
Accepted: Jun. 14, 2016;
Published: Jul. 18, 2016
Views 3150 Downloads 78
Abdoulaye Korse Balde, Department of Visceral Surgery, University Gamal Abdel Nasser of Conakry, Conakry, Guinea
Oumar Taibata Balde, Department of Visceral Surgery, University Gamal Abdel Nasser of Conakry, Conakry, Guinea
Fode Lansana Camara, Department of Visceral Surgery, University Gamal Abdel Nasser of Conakry, Conakry, Guinea
Soriba Naby Camara, Department of Pancretic Surgery, Huazhong University of Science and Technology, Wuhan, China
Hamidou Sylla, Department of Visceral Surgery, University Gamal Abdel Nasser of Conakry, Conakry, Guinea
Amadou Dioulde Diallo, Department of Visceral Surgery, University Gamal Abdel Nasser of Conakry, Conakry, Guinea
Aissatou Taran Diallo, Department of General Surgery, University Gamal Abdel Nasser of Conakry, Conakry, Guinea
Alpha Madiou Barry, Department of Visceral Surgery, University Gamal Abdel Nasser of Conakry, Conakry, Guinea
Ahmed Boubacar Barry, Department of Visceral Surgery, University Gamal Abdel Nasser of Conakry, Conakry, Guinea
Sneha Ballah, Department of General Surgery, University of Mauritius, Mauritius, Mauritius
The aim of this case report is to share our experience in the management of this this rare case of traumatic diaphragmatic rupture in the visceral surgery department of the Hospital of Conakry. Traumatic diaphragmatic rupture is an unfamiliar diagnosis to make and exceptionally seen in some cases of high velocity injuries which involve the abdomen. The high energy from blunt trauma transmitted across the abdomen gives rise to an excessively high pressure in the abdominal cavity which causes shearing of the diaphragmatic muscle. It is indeed considered as a surgical emergency as impaired diaphragmatic movement has a big impact on ventilation and oxygenation of blood. The delay in making appropriate diagnosis due to the lack of overt clinical signs relating to this type of injury accounts for the high mortality rates reaching 31%. We are reporting on a case concerning a 28-year old male patient who was admitted at the department of visceral surgery at the National Hospital of Donka, Conakry, Guinea, for emergency evaluation and treatment of a left sided traumatic diaphragmatic rupture associated with eventration of viscera into the thoracic cavity and contusion of the ascending colon. The mechanism of rupture was determined as a force vector directed frontally and was transmitted across the diaphragmatic wall. A clinical diagnosis was made and confirmed by radiological imaging preoperatively. Prompt surgical intervention was provided within the 1st 24 hours from the time of admission. No complications had been encountered during the post-operative recovery period. The best way to evaluate traumatic diaphragmatic rupture in a patient is through a well-devised systematic approach. It is not advised to perform lengthy imaging tests in a hemodynamically unstable patient and thus, compromising the success of the surgical outcome.
Abdoulaye Korse Balde,
Oumar Taibata Balde,
Fode Lansana Camara,
Soriba Naby Camara,
Amadou Dioulde Diallo,
Aissatou Taran Diallo,
Alpha Madiou Barry,
Ahmed Boubacar Barry,
A Case Report on Diaphragmatic Rupture, in the Visceral Surgery of Hospital of Conakry, Guinea, Journal of Surgery.
Vol. 4, No. 3,
2016, pp. 76-80.
Gray’s Anatomy: The Anatomical Basis of Surgical Practice. Forty-First Editions. 2016, Elsevier Limited.
Killeen KL, Mirvis SE, Shanmuganathan K. Helical CT of diaphragmatic rupture caused by blunt trauma. AJR Am J Roentgenol. 1999; 173 (6): 1611-6. AJR Am J Roentgenol (abstract) – PubMed.
Slim K. Ruptures et plaies du diaphragme. J Chir Masson, Paris, 1999; 136: 67-75.
Al-Nouri O, Hartman B, Freedman R, Thomas C, Esposito T. Diaphragmatic rupture: Is management with biological mesh feasible? Int J Surg Case Rep 2012; 3 (8): 349-53.
Rodrillguez-Morales G, Rodriguez A, Shatney CH. Acute rupture of the diaphragm in blunt trauma: analysis of 60 patients. J Trauma 1986; 26 (5): 438–444.
Gokhan Haciibrahimoglu, Okan Solak, Aysun Olcmen, Mehmet Ali Bedirhan, Nur Solmazer, Atilla Gurses, Management of Traumatic Diaphragmatic Rupture, Surgery Today, February 2004, Volume 34, Issue 2, pp 111-114.
MD Paul A Kearney, PhD Stephen W Rouhana †, MD Richard E Burney, Blunt rupture of the diaphragm: Mechanism, diagnosis, and treatment, Annals of Emergency Medicine, Volume 18, Issue 12, December 1989, Pages 1326-1330.
Nchimi A, Szapiro D, Dondelinger RF. Injuries of the diaphragm. In:, Dondelinger RF, ed. Imaging and intervention in abdominal trauma. Berlin, Germany: Springer-Verlag, 2004; 205–236.
Estrera AS, Platt MR, Mills LJ. Traumatic injuries of the diaphragm. Chest 1979; 75 (3): 306–313.
Shanmuganathan K, Killeen K, Mirvis SE, White CS. Imaging of diaphragmatic injuries. J Thorac Imaging 2000; 15 (2): 104–111.
Go khan Haciibrahimoglu, Okan Solak, Aysun Olcmen, Mehmet Ali Bedirhan, Nur Solmazer, Atilla Gurses, Management of Traumatic Diaphragmatic Rupture, Surgery Today, February 2004, Volume 34, Issue 2, pp 111-114.
Gimena Alexandra Ramírez 1, Jorge Alberto Carrillo 2, Liliana Arias 2, Traumatic diaphragmatic Hernia; Case series and topic review, Rev Colomb Radiol. 2012; 23 (4): 3579-86.
Amber A. Guth, MD 1, H. Leon Pachter, MD 1, Unsup Kim, MD 2, Pitfalls in the diagnosis of blunt diaphragmatic injury, July 1995, Volume 170, Issue 1, Pages 5-9, doi: 10.1016/S0002-9610(99)80242-6.
Walchalk LR, Stanfield SC: Delayed Presentation of Traumatic Diaphragmatic Rupture. Journal of Emergency Medicine. 2008.
Bocchini G; Guida F; Sica G; Codella U& Scaglione M. Diaphragmatic injuries after blunt trauma: are they still a challenge? Emerg Radiol (2012) 19: 225–235.
Turki M, Barhoumi MH, Hajji H, Chemchik H, M’barek B Rupture diaphragmatique droite avec passage total et isolé du foie en intrathoracique Pan African Medical Journal. 2011; 10: 28: 1-7.
Chao CM, Chang CH, Lai CC. Traumatic rupture of diaphragm. Am J Med Sci. 2012 Aug; 344 (2): 127.
Mutter D., Schmidt-Mutter C., Marescaux J. Contusions et plaies de l’abdomen. EMC (Elsevier SAS, Paris), Urgences, 24-100-B-30, 2005.
Hwang SW, Kim HY, Byun JH. Management of Patients with Traumatic Rupture of the Diaphragm. Korean J Thorac Cardiovasc Surg 2011; 44: 348-354.
http://www.aast.org/Library/TraumaTools/InjuryScoringScales.aspx#diaphragm, From Moore et al. ; with permission.
Karim Brohi, CLASSIC CASES Late presentation of diaphragm rupture following blunt thoracic trauma, trauma.org (7:1) January 2002.
Abha Chandra, M. Ch., Aloka Samantaray*, MD, Govini Balasubramani, MS, Rajendra Sonawane**, M. Ch, Surgical management of diaphragmatic injuries, IJTCVS 203 2007; 23: 202–207.