Laparoscopic repair of acute traumatic diaphragmatic hernia with mesh reinforcement: A case report

Introduction and importance: Traumatic diaphragmatic injuries are rare and usually occur after thoracoabdominal trauma. Most patients will have other potentially life-threatening injuries. High index of suspicion is the most important attribute. Unfortunately, it is incorrectly diagnosed in up to 33...

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Autores principales: Gielis, Manuel, Bruera, Nicolás, Pinsak, Agustín, Olmedo, Ignacio, Fabián, Paez Walter, Viscido, Germán Rodrigo
Formato: Artículo
Lenguaje:Español
Publicado: Elsevier Ltd 2022
Materias:
R Medicina (General)
RD Cirugía
Acceso en línea:http://pa.bibdigital.ucc.edu.ar/3286/1/A_Gielis_Bruera_Pinsak.pdf
Aporte de:
Producción Académica Universidad Católica de Córdoba (UCCor) de Universidad Católica de Córdoba
id I38-R144-3286
record_format dspace
spelling I38-R144-32862025-04-10T18:35:04Z http://pa.bibdigital.ucc.edu.ar/3286/ Laparoscopic repair of acute traumatic diaphragmatic hernia with mesh reinforcement: A case report Gielis, Manuel Bruera, Nicolás Pinsak, Agustín Olmedo, Ignacio Fabián, Paez Walter Viscido, Germán Rodrigo R Medicina (General) RD Cirugía Introduction and importance: Traumatic diaphragmatic injuries are rare and usually occur after thoracoabdominal trauma. Most patients will have other potentially life-threatening injuries. High index of suspicion is the most important attribute. Unfortunately, it is incorrectly diagnosed in up to 33% of cases. If left untreated, the onset of complications carries mortality rates between 25 and 80%. Case presentation: We report a case of an acute diaphragmatic laceration in a 29-year-old male with thoracoabdominal trauma due to a road traffic accident. Physical examination revealed an absence of normal breath sounds in the left hemithorax. CT-scan confirmed a voluminous left diaphragmatic hernia with omental, gastric, and transverse colon content, so surgical intervention was advised. During laparoscopy, a 15 cm long and 5 cm wide diaphragmatic defect was identified. The hernia was reduced laparoscopically, and the defect repaired with interrupted non-absorbable sutures. As a reinforcement, a visceral contact prosthesis was placed. The patient had an uneventful recovery and after 12-month follow-up he has no evidence of recurrence. Clinical discussion: Diaphragmatic injuries do not close spontaneously. An abdominal approach is recommended as it allows for evaluation of the entire abdomen and treatment of any associated injury. Watertight closure with nonabsorbable suture and in case of large defects, the placement of a mesh on the peritoneal side of the diaphragm is recommended to reinforce the primary repair. Conclusion: Laparoscopic emergency surgery has proved to be effective and safe in selected patients with hemodynamic stability. Patients can expect the benefits of minimal invasive surgery with recurrence rate like the open approach. Elsevier Ltd 2022-04 info:eu-repo/semantics/article info:eu-repo/semantics/closedAccess application/pdf spa http://pa.bibdigital.ucc.edu.ar/3286/1/A_Gielis_Bruera_Pinsak.pdf Gielis, Manuel, Bruera, Nicolás, Pinsak, Agustín, Olmedo, Ignacio, Fabián, Paez Walter and Viscido, Germán Rodrigo ORCID: https://orcid.org/0000-0001-5347-3141 <https://orcid.org/0000-0001-5347-3141> (2022) Laparoscopic repair of acute traumatic diaphragmatic hernia with mesh reinforcement: A case report. International Journal of Surgery Case Reports, 93. ISSN 2210-2612 https://www.sciencedirect.com/science/article/pii/S2210261222001560?via%3Dihub info:eu-repo/semantics/altIdentifier/doi/https://doi.org/10.1016/j.ijscr.2022.106910
institution Universidad Católica de Córdoba
institution_str I-38
repository_str R-144
collection Producción Académica Universidad Católica de Córdoba (UCCor)
language Español
orig_language_str_mv spa
topic R Medicina (General)
RD Cirugía
spellingShingle R Medicina (General)
RD Cirugía
Gielis, Manuel
Bruera, Nicolás
Pinsak, Agustín
Olmedo, Ignacio
Fabián, Paez Walter
Viscido, Germán Rodrigo
Laparoscopic repair of acute traumatic diaphragmatic hernia with mesh reinforcement: A case report
topic_facet R Medicina (General)
RD Cirugía
description Introduction and importance: Traumatic diaphragmatic injuries are rare and usually occur after thoracoabdominal trauma. Most patients will have other potentially life-threatening injuries. High index of suspicion is the most important attribute. Unfortunately, it is incorrectly diagnosed in up to 33% of cases. If left untreated, the onset of complications carries mortality rates between 25 and 80%. Case presentation: We report a case of an acute diaphragmatic laceration in a 29-year-old male with thoracoabdominal trauma due to a road traffic accident. Physical examination revealed an absence of normal breath sounds in the left hemithorax. CT-scan confirmed a voluminous left diaphragmatic hernia with omental, gastric, and transverse colon content, so surgical intervention was advised. During laparoscopy, a 15 cm long and 5 cm wide diaphragmatic defect was identified. The hernia was reduced laparoscopically, and the defect repaired with interrupted non-absorbable sutures. As a reinforcement, a visceral contact prosthesis was placed. The patient had an uneventful recovery and after 12-month follow-up he has no evidence of recurrence. Clinical discussion: Diaphragmatic injuries do not close spontaneously. An abdominal approach is recommended as it allows for evaluation of the entire abdomen and treatment of any associated injury. Watertight closure with nonabsorbable suture and in case of large defects, the placement of a mesh on the peritoneal side of the diaphragm is recommended to reinforce the primary repair. Conclusion: Laparoscopic emergency surgery has proved to be effective and safe in selected patients with hemodynamic stability. Patients can expect the benefits of minimal invasive surgery with recurrence rate like the open approach.
format Artículo
author Gielis, Manuel
Bruera, Nicolás
Pinsak, Agustín
Olmedo, Ignacio
Fabián, Paez Walter
Viscido, Germán Rodrigo
author_facet Gielis, Manuel
Bruera, Nicolás
Pinsak, Agustín
Olmedo, Ignacio
Fabián, Paez Walter
Viscido, Germán Rodrigo
author_sort Gielis, Manuel
title Laparoscopic repair of acute traumatic diaphragmatic hernia with mesh reinforcement: A case report
title_short Laparoscopic repair of acute traumatic diaphragmatic hernia with mesh reinforcement: A case report
title_full Laparoscopic repair of acute traumatic diaphragmatic hernia with mesh reinforcement: A case report
title_fullStr Laparoscopic repair of acute traumatic diaphragmatic hernia with mesh reinforcement: A case report
title_full_unstemmed Laparoscopic repair of acute traumatic diaphragmatic hernia with mesh reinforcement: A case report
title_sort laparoscopic repair of acute traumatic diaphragmatic hernia with mesh reinforcement: a case report
publisher Elsevier Ltd
publishDate 2022
url http://pa.bibdigital.ucc.edu.ar/3286/1/A_Gielis_Bruera_Pinsak.pdf
work_keys_str_mv AT gielismanuel laparoscopicrepairofacutetraumaticdiaphragmaticherniawithmeshreinforcementacasereport
AT brueranicolas laparoscopicrepairofacutetraumaticdiaphragmaticherniawithmeshreinforcementacasereport
AT pinsakagustin laparoscopicrepairofacutetraumaticdiaphragmaticherniawithmeshreinforcementacasereport
AT olmedoignacio laparoscopicrepairofacutetraumaticdiaphragmaticherniawithmeshreinforcementacasereport
AT fabianpaezwalter laparoscopicrepairofacutetraumaticdiaphragmaticherniawithmeshreinforcementacasereport
AT viscidogermanrodrigo laparoscopicrepairofacutetraumaticdiaphragmaticherniawithmeshreinforcementacasereport
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