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Elkbuli A, Meneses E, Shepherd A, et al. Traumatic diaphragmatic rupture successfully managed in 4-year-old patient: Case report and literature review. Int J Surg Case Rep. 2020;72:237-240doi: 10.1016/j.ijscr.2020.06.026.
Elkbuli, A., Meneses, E., Shepherd, A., McKenney, M., & Boneva, D. (2020). Traumatic diaphragmatic rupture successfully managed in 4-year-old patient: Case report and literature review. International journal of surgery case reports, 72237-240. https://doi.org/10.1016/j.ijscr.2020.06.026
Elkbuli, Adel, et al. "Traumatic diaphragmatic rupture successfully managed in 4-year-old patient: Case report and literature review." International journal of surgery case reports vol. 72 (2020): 237-240. doi: https://doi.org/10.1016/j.ijscr.2020.06.026
Elkbuli A, Meneses E, Shepherd A, McKenney M, Boneva D. Traumatic diaphragmatic rupture successfully managed in 4-year-old patient: Case report and literature review. Int J Surg Case Rep. 2020;72:237-240. doi: 10.1016/j.ijscr.2020.06.026. Epub 2020 Jun 11. PMID: 32553935; PMCID: PMC7300228.
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Int J Surg Case Rep. 2020;72:237-240. doi: 10.1016/j.ijscr.2020.06.026. Epub 2020 Jun 11.

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

International journal of surgery case reports

Adel Elkbuli, Evander Meneses, Aaron Shepherd, Mark McKenney, Dessy Boneva

Affiliations

  1. Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA. Electronic address: [email protected].
  2. Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA.
  3. Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA; University of South Florida, Tampa, FL, USA.

PMID: 32553935 PMCID: PMC7300228 DOI: 10.1016/j.ijscr.2020.06.026

Abstract

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.

Copyright © 2020 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Keywords: Motor vehicle collisions; Pediatric trauma; Trauma outcomes; Traumatic diaphragmatic hernia

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