[Post trauma diaphragmatic hernia].
Posttraumatic diaphragmatic hernias may occur after blunt or penetrating trauma. Due to coexisting injuries and the silent nature of the diaphragmatic lesions, the diagnosis can sometimes be missed in the acute phase and may present later on with obstructive symptoms due to incarcerated organs in the diaphragmatic defect.


METHODS
We perform a retrospective study of all operated cases at our institution during the last 20 years.


RESULTS
23 patients were included, 17 men and 6 women. 21 patients presented antecedents of blunt trauma and 2 of penetrating one. 7 patients were diagnosed in acute phase, manifesting as acute abdomen and hemodynamic instability. 13 patients were diagnosed in chronic phase, 4 of them with respiratory symptoms and 9 with bowel obstruction symptoms. 3 patients were asymptomatic and the diagnosis was an incidental finding. 12 patients underwent elective surgery and 11 emergency surgery, 7 of them in acute phase and 4 in chronic complicated one. Abdominal approach was performed in all the patients. Laparoscopic approach was unsuccessfully tried in one patient. The hernia was located in the left hemidiaphragm in 16 patients, in the right one in 6 and in one case the defect was bilateral. Mesh was placed in only 2 cases. Intraoperative mortality appeared in one patient with acute diaphragmatic hernia due to coexisting hepatic lesions and morbidity appeared in only 1 patients, presented as a respiratory sepsis.


CONCLUSIONS
Posttraumatic diaphragmatic hernia is a rare clinical entity of difficult diagnosis. In the chronic phase, there is a high risk of visceral strangulation or respiratory symptoms.
Ruiz-Tovar
Jaime
J
Servicio de Cirugía de General y del Aparato Digestivo, Hospital Universitario Ramón y Cajal, Madrid, España. jruiztovar@gmail.com
Calero García
Purificación
P
Morales Castiñeiras
Vicente
V
Martínez Molina
Enrique
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004630:Emergencies; D005260:Female; D006549:Hernia, Diaphragmatic, Traumatic / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013526:Surgical Mesh