Treatment of diaphragmatic traumatic hernia

Medicine Journal

Medicine Journal 2 2007; 101-123

The traumatic rupture of the diaphragm is an uncommon, resultant condition of impact, with distortion of the thoracic wall, increase of the intra-abdominal pressure, and consequence diaphragm injury. It occurs approximately in 5% of the patients with severe tóraco-abdominal trauma, and abdominal herniation of viscera for the thorax in 45- 60% of the cases. 75% of the injuries are caused by closed trauma (contusio) and 25% and 25% result of penetrating trauma.The diagnostic pre-operation of the injuries of the diaphragm for closed trauma, although desirable, is difficult. The majority of the injuries is not diagnosised readily, since its signals and symptoms, also radiological, are not specific, being frequently attributed to other more common injuries. Thus, the diafragmática rupture can recognized and not be treated immediately, resulting, after a latent period, that can last months or years, in gradual herniation of the abdominal structures for the interior of the thorax, what it can determine visceral strangulation, with high mortality. Theauthors argue some taken care of illustrative cases in the Service. The traumatic diafragmática hernia constitutes an infrequent problem for the surgeon of the trauma, and needs one high index of suspicion for its diagnosis, especially in the cases of closed trauma. The diagnosis can pass unobserved when the clinical suspicion does not exist. X-ray examination constituen a good one for assisting in the diagnosis. The main ways are argued to arrive at the diagnosis, as well as the basic principles for the repair of these injuries. WORDS KEYS : Traumatic diaphragmatica hernia; surgery; thorax trauma; complications.
February 2007
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