Traumatic diaphragmatic hernia in children

Abstract

Traumatic diaphragmatic hernia is a relatively uncommon clinical entity, especially in children. It is often undiagnosed because of its rarity and coexistence with more obvious and serious injuries. Mortality of traumatic diaphragmatic rupture alone is rare, however delayed diagnosis may lead to higher mortality and morbidity rate. Outcome is usually determined by concomitant injuries and complications. Usually a diaphragmatic injury occurs in cases of blunt abdominal trauma (e.g. motor vehicle accidents) or penetrating trauma (e.g. gunshot or stab injury). Iatrogenic causes are rare. It has three stages: 1. initial, 2. latent, and 3. obstructive. Clinical findings vary depending on the stage of traumatic diaphragmatic injury. Subsequent complications, such as herniation or strangulation of viscera may occur months or even years after primary injury. High index of suspicion of this injury should be maintained when dealing with patients having respiratory or abdominal symptoms following trauma of the thoracoabdominal region, and patients after high-velocity blunt abdominal or penetrating trauma. We present two cases of traumatic diaphragmatic rupture and subsequent diaphragmatic hernia in pediatric patients, admitted in our hospital 2 months apart in a row, with different clinical and radiological findings.

Keywords

• Pediatric trauma
• Traumatic diaphragmatic rupture
• Blunt abdominal trauma