Traumatic diaphragmatic hernia pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-in-Chief: Awni D. Shahait, M.D.[2], The University of Jordan
Pathophysiology
Diaphragmatic injuries are caused either by penetrating or blunt injuries to the abdomen. They are diagnosed immediately as part of multi-organ injury, or present later either with respiratory distress or as intestinal obstruction.[1] The mechanism in blunt injury is explained by shearing of a stretched membrane, avulsion at the point of diaphragmatic attachment, and the sudden force transmission through viscera acting as viscous fluid. Left sided injuries are more often seen. Left-sided rupture occurred in 68.5% of the patients, 24.2% had right-sided rupture, 1.5% had bilateral rupture, 0.9% had pericardial rupture, and 4.9% were unclassified.[2] Increased strength of the right hemi-diaphragm, hepatic protection of the right side, under diagnosis of right-sided ruptures, and weakness of the left hemi-diaphragm at points of embryonic fusion all have been proposed to explain the predominance of left sided diaphragmatic injuries.[2] Autopsy studies reveals that the incidence of rupture is almost equal on both sides but the greater force needed for the right rupture. A positive pressure gradient of 7-20 cms of H2O between the intraperitoneal and the intra pleural cavities forces the contents into the thorax. With severe blunt trauma the pressures may rise to as high as 100cms of water.
It can occur after splenectomy.[3]
Because it can be indicative of severe trauma, it often co-presents with pelvic fracture.[4]
References
- ↑ CARTER BN, GIUSEFFI J, FELSON B (1951). "Traumatic diaphragmatic hernia". Am J Roentgenol Radium Ther. 65 (1): 56–72. PMID 14799666. Unknown parameter
|month=ignored (help) - ↑ 2.0 2.1 Ala-Kulju K, Verkkala K, Ketonen P, Harjola PT (1986). "Traumatic rupture of the right hemidiaphragm". Scand J Thorac Cardiovasc Surg. 20 (2): 109–14. PMID 3738439.
- ↑ Tsuboi K, Omura N, Kashiwagi H, Kawasaki N, Suzuki Y, Yanaga K (2008). "Delayed traumatic diaphragmatic hernia after open splenectomy: report of a case". Surg. Today. 38 (4): 352–4. doi:10.1007/s00595-007-3627-0. PMID 18368327.
- ↑ Meyers BF, McCabe CJ (1993). "Traumatic diaphragmatic hernia. Occult marker of serious injury". Ann. Surg. 218 (6): 783–90. PMC 1243075. PMID 8257229. Unknown parameter
|month=ignored (help)