Intestinal obstruction. A rare delayed presentation of traumatic - PDF document

See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/6837773 Intestinal obstruction. A rare delayed presentation of traumatic diaphragmatic hernia Article in Saudi medical journal · October 2006 Source: PubMed CITATIONS READS 2 35 3 authors , including: Hooman Yarmohammadi Leila Ghahramani Memorial Sloan Kettering Cancer Center colorectal research center ,Shiraz University of Medical Sciences, Shiraz, Iran 187 PUBLICATIONS 1,512 CITATIONS 96 PUBLICATIONS 221 CITATIONS SEE PROFILE SEE PROFILE Some of the authors of this publication are also working on these related projects: Embolization of Metastatic Neuroendocrine Tumor Resulting in Clinical Manifestations of Syndrome of Inappropriate Secretion of Antidiuretic Hormone View project article View project All content following this page was uploaded by Hooman Yarmohammadi on 01 June 2014. The user has requested enhancement of the downloaded file.

Clinical Notes Intestinal obstruction. A rare delayed progressively improved, and he was discharged after presentation of traumatic diaphragmatic 5 days. hernia The presented case, is a classic example of a patient presenting with intestinal obstruction, caused by strangulation. He had nausea, obstipation, and Hooman Yarmohammadi, MD, the radiological evaluations were also in favor of Leyla Ghahramani , MD, an intestinal obstruction. The most common cause Abdoulrasoul Talei, MD. of post operation (post op) intestinal obstruction is the adhesion band. 2 Therefore, the most probable T raumatic diaphragmatic injuries, commonly diagnosis was the adhesion band. However, in our occur following blunt and penetrating trauma, case, the cause was a delayed TDH or chronic and due to coexisting injuries and the silent nature of diaphragmatic hernia. This is a common mistake, diaphragmatic injuries, the diagnosis is easily missed also observed in other institutions. In fact, delayed or diffjcult during the fjrst evaluation, resulting TDH are observed in approximately 10% of in chronic diaphragmatic hernia, strangulation, or diaphragmatic injuries. 1 Due to coexisting injuries both. Traumatic diaphragmatic hernias (TDH) when and the silent nature of diaphragmatic injuries, the diagnosed many years after the traumatic event, are diagnosis is easily missed or diffjcult. In a study observed in approximately 10% of diaphragmatic performed by Ramos et al, 3 a retrospective study injuries. 1 In this study, we present a case of to identify pitfalls in the diagnosis and treatment delayed TDH presenting with intestinal obstruction of traumatic diaphragmatic injuries in children or strangulation to emphasize precise physical was performed. The authors evaluated 15 cases of examination, interpretation of radiographic images, traumatic diaphragmatic rupture. Associated injuries, and accurate pre-operative diagnosis. included, liver lacerations (47%), pelvic fractures A 54-year-old man presented to the surgical (47%), major vessels tear (40%), bowel perforations emergency department, complaining of cramped (33%), long bone fractures (20%), renal lacerations abdominal pain, nausea, vomiting (non-bloody), (20%), splenic lacerations (13%), and closed head and abdominal distention for 3 days. He had no injuries (13%). 3 They concluded that, TDH are usually gas passing or bowel movement in the past 24 associated with serious injuries in children, and it is hours. He had a car accident 15 years ago, in which important to combine a high index of suspicion with laparotomy and splenectomy were performed, due to radiological diagnostic tests in patients at risk. 3 Our internal bleeding and splenic laceration. In addition, patient was a victim of a car accident. He was brought he sustained a penetrating trauma to the right side of his chest and a thoracotomy tube was inserted. His hospital course was uneventful, and he was discharged after 7 days. On arrival, his vital signs were: Pulse rate: 110/min; respiratory rate: 35/min; blood pressure: 140/90 mm Hg; Temperature: 37.8ºC. He had a distended and generally tender abdomen with no rebound tenderness. A 2.5 cm linear scar was observed on the right side of his chest, due to the old penetrating laceration. Bowel sounds were loud and highly frequent. Rectal examination revealed an empty rectum, and other physical examinations were normal. Radiograph imaging (fmat and upright of abdomen, and chest x-ray [CXR]), revealed generalized small and large bowel distention, and for intestinal obstruction ( Figure 1 ). He was taken to the operating room and with the impression of intestinal obstruction caused by adhesion band, laparotomy Figure 1 - Abdominal x-ray (fmat x-ray) of our 54-year-old patient. was performed. A 3 x 3 cm defect was found in the The x-ray was taken with the patient in the supine posi- - diaphragm and the jejunum had strangulated in it. tion. A gas distended bowel is present, both in the large Fortunately, the bowel was not gangrenous, and after and small bowel, however, small bowel distention is more its release, the diaphragm was repaired. His condition prominently observed. www.smj.org.sa Saudi Med J 2006; Vol. 27 (9) 1425 03intestinal obstruction_MS 20051425 1425 03/09/2006 1:09:11 PM