Resumo
Diaphragmatic hernia secondary to blunt or penetrating trauma is rarely by itself a fatal event. However, if unpercieved, it may lead to severe complications caused by herniation of abdominal contents to the ethorax. Blunt trauma related to car accidents is the most frequent cause of diaphragmatic hernias. Associated injuries are frequently observed, provoked by severe traumas of great impact. These blunt trauma hernias occur mainly on the left side due to abdominal anatomy, since the liver is usually located on the right side. When injuries are observed on the right they tend to be more severe, generally related to major trauma of solid organs. Less frequently diaphragmatic hernias may be bilateral. The management of diaphragmatic injury would appear to be a simple matter of suturing the defect. However, peroperative diagnosis can be difficult and even at the time of surgery some diaphragmatic injuries can be overlooked if carefull exploration is not done. Associated injuries tend to divert attention from the diaphragmatic injury. Laparoscopic diagnosis and repair have been described with successfull. Laparotomy or thoracotomy can be employed for surgical repair of traumatic diaphragmatic hernias. Standard (laboratory/imaging) examinations may fail to make the diagnosis. Recently, the laparoscopic approach has proved useful for more precise evaluation of such injuries, very often allowing immediate repair of these lesions.
Traumatic diaphragmatic hernia; Laparoscopy
Traumatic diaphragmatic hernia; Laparoscopy
RELATOS DE CASOS
Correção laparoscópica de hérnia diafragmática traumática crônica
Management of chronic traumatic diaphragmatic hernia
Cartas Eduardo Domene, TCBC-SPI; Paula Volpe, ACBC-SPII; Ingrid BirbojmIII; Henrique Walter Pinotti, TCBC-SPIV
IProfessor Livre-Docente da Disciplina de Cirurgia do Aparelho Digestivo do Hospital das Clínicas - FMUSP
IIMédica Preceptora e Pós-Graduanda da Disciplina de Cirurgia do Aparelho Digestivo do Hospital das Clínicas - FMUSP
IIIAcadêmica de 5° ano da FMUSP
IVProfessor Titular da Disciplina de Cirurgia do Aparelho Digestivo do Hospital das Clínicas - FMUSP
Endereço para correspondência Endereço para correspondência: Dr. Carlos Eduardo Domene Av. Amolfo de Azevedo, 201 01236-030 - São Paulo -SP
ABSTRACT
Diaphragmatic hernia secondary to blunt or penetrating trauma is rarely by itself a fatal event. However, if unpercieved, it may lead to severe complications caused by herniation of abdominal contents to the ethorax. Blunt trauma related to car accidents is the most frequent cause of diaphragmatic hernias. Associated injuries are frequently observed, provoked by severe traumas of great impact. These blunt trauma hernias occur mainly on the left side due to abdominal anatomy, since the liver is usually located on the right side. When injuries are observed on the right they tend to be more severe, generally related to major trauma of solid organs. Less frequently diaphragmatic hernias may be bilateral. The management of diaphragmatic injury would appear to be a simple matter of suturing the defect. However, peroperative diagnosis can be difficult and even at the time of surgery some diaphragmatic injuries can be overlooked if carefull exploration is not done. Associated injuries tend to divert attention from the diaphragmatic injury. Laparoscopic diagnosis and repair have been described with successfull. Laparotomy or thoracotomy can be employed for surgical repair of traumatic diaphragmatic hernias. Standard (laboratory/imaging) examinations may fail to make the diagnosis. Recently, the laparoscopic approach has proved useful for more precise evaluation of such injuries, very often allowing immediate repair of these lesions.
Key words: Traumatic diaphragmatic hernia; Laparoscopy.
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Recebido em 13/11/97
Aceito para publicação em 16/4/98
Trabalho realizado na Disciplina de Cirurgia do Aparelho Digestivo do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo.
- 1. Zantut LFC, Machado MAC, Volpe P, et al. Bilateral diaphragmatic injury diagnosed by laparoscopy. Rev Paul Med 1993;111(3): 430-432.
- 2. Rasiah KK, Phillip JC. Laparoscopic repair of a traumatic diaphragrnatic hernia. J Laparoendoscop Surg 1995; 5 (6):405-407.
- 3. Mc Collum C, Anyanwu CH, Umeh BUO, et al. Management of traumatic rupture of the diaphragm. Br J Surg 1987;74:181-183.
- 4. Pioner SR, Coral RP, Weston AC, et al. Hérnia diafragmática traumática crônica. Rev Col Bras Cir 1996; 23 (1):13-16.
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5Domene CE. Cardiomiectomia com fundoplicatura parcial video-laparoscópica no tratamento do megaesôfago não avançado. Sistematização técnica. Avaliação clínica e funcional. Tese Livre-Docência. Faculdade de Medicina da Universidade de São Paulo, São Paulo, 1996.
Endereço para correspondência:
Datas de Publicação
-
Publicação nesta coleção
28 Jul 2010 -
Data do Fascículo
Jun 1998
Histórico
-
Aceito
16 Abr 1998 -
Recebido
13 Nov 1997
