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Traumatic diaphragmatic rupture successfully managed in 4-year-old patient: Case report and literature review

INTRODUCTION: Traumatic diaphragmatic ruptures are rare injuries in the pediatric population that can present with dyspnea, abdominal pain, or even be asymptomatic. CASE PRESENTATION: A 4-year-old boy presents to our Level 1 Pediatric Trauma Center after being hit by a car. He presented awake and al...

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Autores principales: Elkbuli, Adel, Meneses, Evander, Shepherd, Aaron, McKenney, Mark, Boneva, Dessy
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7300228/
https://www.ncbi.nlm.nih.gov/pubmed/32553935
http://dx.doi.org/10.1016/j.ijscr.2020.06.026
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author Elkbuli, Adel
Meneses, Evander
Shepherd, Aaron
McKenney, Mark
Boneva, Dessy
author_facet Elkbuli, Adel
Meneses, Evander
Shepherd, Aaron
McKenney, Mark
Boneva, Dessy
author_sort Elkbuli, Adel
collection PubMed
description INTRODUCTION: Traumatic diaphragmatic ruptures are rare injuries in the pediatric population that can present with dyspnea, abdominal pain, or even be asymptomatic. CASE PRESENTATION: A 4-year-old boy presents to our Level 1 Pediatric Trauma Center after being hit by a car. He presented awake and alert but with low oxygen saturations and chief complaint of left sided abdominal and chest pain. The initial chest radiograph showed an elevated left diaphragm and bilateral opacities. A laparoscopic approach confirmed the diagnosis of a diaphragm rupture and an open approach allowed for the diaphragm repair, after returning the stomach, colon and spleen back to the abdominal cavity. He had an uneventful recovery and was discharged home on postoperative day seven. DISCUSSION: Traumatic diaphragmatic hernia continues to be a difficult diagnosis to make without a high index of suspicion with variable time to diagnosis. This has been attributed to nonspecific clinical presentation and low incidence of the condition. Chest radiograph has been suggested to be an appropriate initial imaging modality with computed tomography as an accurate adjunct. Right sided diaphragm hernias, although less common, still occur and are often misdiagnosed. Recovery without significant morbidity after definitive surgical treatment with laparotomy is common. CONCLUSION: Consider a traumatic diaphragmatic hernia in a blunt pediatric trauma patient with abdominal pain and dyspnea once other life-threatening injuries have been ruled out. This is an easily missed injury that can lead to significant morbidity and mortality if not identified early in the patient’s hospital course.
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spelling pubmed-73002282020-06-22 Traumatic diaphragmatic rupture successfully managed in 4-year-old patient: Case report and literature review Elkbuli, Adel Meneses, Evander Shepherd, Aaron McKenney, Mark Boneva, Dessy Int J Surg Case Rep Article INTRODUCTION: Traumatic diaphragmatic ruptures are rare injuries in the pediatric population that can present with dyspnea, abdominal pain, or even be asymptomatic. CASE PRESENTATION: A 4-year-old boy presents to our Level 1 Pediatric Trauma Center after being hit by a car. He presented awake and alert but with low oxygen saturations and chief complaint of left sided abdominal and chest pain. The initial chest radiograph showed an elevated left diaphragm and bilateral opacities. A laparoscopic approach confirmed the diagnosis of a diaphragm rupture and an open approach allowed for the diaphragm repair, after returning the stomach, colon and spleen back to the abdominal cavity. He had an uneventful recovery and was discharged home on postoperative day seven. DISCUSSION: Traumatic diaphragmatic hernia continues to be a difficult diagnosis to make without a high index of suspicion with variable time to diagnosis. This has been attributed to nonspecific clinical presentation and low incidence of the condition. Chest radiograph has been suggested to be an appropriate initial imaging modality with computed tomography as an accurate adjunct. Right sided diaphragm hernias, although less common, still occur and are often misdiagnosed. Recovery without significant morbidity after definitive surgical treatment with laparotomy is common. CONCLUSION: Consider a traumatic diaphragmatic hernia in a blunt pediatric trauma patient with abdominal pain and dyspnea once other life-threatening injuries have been ruled out. This is an easily missed injury that can lead to significant morbidity and mortality if not identified early in the patient’s hospital course. Elsevier 2020-06-11 /pmc/articles/PMC7300228/ /pubmed/32553935 http://dx.doi.org/10.1016/j.ijscr.2020.06.026 Text en © 2020 IJS Publishing Group Ltd. Published by Elsevier Ltd. http://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Elkbuli, Adel
Meneses, Evander
Shepherd, Aaron
McKenney, Mark
Boneva, Dessy
Traumatic diaphragmatic rupture successfully managed in 4-year-old patient: Case report and literature review
title Traumatic diaphragmatic rupture successfully managed in 4-year-old patient: Case report and literature review
title_full Traumatic diaphragmatic rupture successfully managed in 4-year-old patient: Case report and literature review
title_fullStr Traumatic diaphragmatic rupture successfully managed in 4-year-old patient: Case report and literature review
title_full_unstemmed Traumatic diaphragmatic rupture successfully managed in 4-year-old patient: Case report and literature review
title_short Traumatic diaphragmatic rupture successfully managed in 4-year-old patient: Case report and literature review
title_sort traumatic diaphragmatic rupture successfully managed in 4-year-old patient: case report and literature review
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7300228/
https://www.ncbi.nlm.nih.gov/pubmed/32553935
http://dx.doi.org/10.1016/j.ijscr.2020.06.026
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