Acute diaphragmatic rupture caused by blunt trauma

An acute ruptured diaphragm due to blunt trauma was found to be an injury sustained primarily by young men as a result of high speed automobile accidents. It was frequently associated with multiple injuries, such as a ruptured spleen and liver, and skeletal injuries, most commonly pelvic and rib fractures. The chest roentgenogram was diagnostic in ten of the eleven patients although serial films were required in two patients.     

Isolated coronary artery rupture following blunt chest trauma. A case report

In connection with blunt chest trauma, a 44-year-old man sustained isolated rupture of the right coronary artery. The lesion, which is extremely rare, was overlooked as there was no haemopericardium. The patient died. Since early surgical repair is essential, the possibility of coronary artery lesion must be kept in mind in all cases of severe thoracic trauma.     

Delayed blow-out type rupture of the right ventricle following blunt chest trauma

A 36-year-old man suffered multiple traumatic injuries when he fell from a crane. Fractures of both lower extremities, a compression fracture of the fourth lumbar vertebra, and bilateral hemopneumothoraxes were identified. The sternum was not fractured, but was tender. The day after admission, the right ventricular free wall ruptured and was diagnosed by echocardiography. An emergency operation was performed. A Gore-tex^? sheet was sutured from inside the ventricle, and a Hemashield^TM graft was sutured over the tear. The risk of hemorrhage is high in the patient with multiple traumatic injuries when heparin is required. Mechanical ventilation was required until the 13^th postoperative day because persistent hemothorax. After an operation to reduce a leg fracture, the patient was discharged from the hospital on the 66^th postoperative day.     

Isolated gallbladder rupture due to blunt abdominal trauma

Traumatic injury to the extrahepatic biliary system is rare and usually diagnosed at laparotomy when it is associated with other visceral injuries. Isolated gallbladder rupture due to blunt abdominal trauma is even rarer. The clinical presentation of gallbladder injury is variable, resulting in a delay in diagnosis and treatment. Awareness to the possibility of trauma to the extrahepatic biliary system enables early surgical intervention and eliminates the high morbidity associated with delated diagnosis. A 5 year old child with isolated gallbladder rupture caused by blunt abdominal trauma is presented.     

Isolated rupture of the right upper pulmonary vein: a blunt cardiac trauma case

A 37-year-old woman who sustained blunt chest trauma as a result of a car accident was found unconscious at the accident site with signs of circulatory compromise. Computed tomographic trauma screening excluded thoracic, intracranial, and intra-abdominal bleeding, or other pathologic findings, except a small circumferential hemopericardium. Echocardiography revealed a hemopericardium that was partially clotted and the beginning of compression of the right ventricle. Because of progressive hemodynamic compromise, the decision was made for operative exploration. After a median sternotomy, the resultant excessive bleeding necessitated extracorporeal circulation. Careful inspection revealed isolated rupture of the upper right pulmonary vein, which was successfully repaired.     

Missed diaphragm rupture following blunt trauma.

Traumatic rupture of the diaphragm resulting from blunt trauma remains a challenging clinical entity. Diagnosis remains difficult and is often delayed. A prompt diagnosis requires a high index of suspicion. We describe two patients with ruptured diaphragms in whom the diagnosis was made at different stages of their illness. The diaphragmatic injury reflects the magnitude of their associated injuries and probably contributes to the overall mortality.     

Intrathoracic tracheal rupture following blunt chest trauma

Intrathoracic tracheal rupture following closed chest trauma is a potentially lethal injury which can be successfully repaired if the diagnosis is made early. Dyspnoea, mediastinal emphysema and pneumothorax which do not respond to intercostal tube drainage should alert the clinician to the possibility of intrathoracic tracheal rupture. A case is described. A 17-year-old boy sustained two longitudinal lacerations of the membranous portion of the intrathoracic trachea in association with blunt chest trauma. The diagnosis was delayed because of coexisting head injury. The tracheal lacerations were successfully repaired via a right thoracotomy. The principles of management in such injuries are reviewed.     

Right-sided diaphragmatic rupture after blunt trauma. An unusual entity

Traumatic injuries of the diaphragm remain an entity of difficult diagnosis despite having been recognised early in the history of surgery, especially when it comes to blunt trauma and injuries of the right diaphragm. We report the case of a patient with blunt trauma with right diaphragmatic rupture that required urgent surgical treatment for hepatothorax and iatrogenic severe liver injury. Blunt trauma can cause substantial diaphragmatic rupture. It must have a high index of suspicion for diaphragmatic injury in patients, victims of vehicle collisions, mainly if they have suffered frontal impacts and/or side precipitates in patients with severe thoracoabdominal trauma. The diagnosis can be performed clinically and confirmation should be radiological. The general measures for the management of multiple trauma patients must be applied. Surgery at the time of diagnosis should restore continuity.     

Isolated colonic injury following blunt abdominal trauma

A case of delayed diagnosis of colonic injury after blunt abdominal trauma leading to faecal peritonitis is presented. Diagnostic problems and possibilities as well as treatment of these injuries are reviewed. The key to diagnosis remains the serial clinical and ultrasound examinations.     

Isolated rupture of the cisterna chyli after blunt trauma

An 8-year-old boy was evaluated for blunt abdominal trauma after a motor vehicle crash. In the course of his workup, a computed tomography (CT) scan of the abdomen was suspicious for a duodenal injury. At surgery, the duodenum was found to be normal; however, a rupture of the cisterna chyli was identified. This injury was repaired, and the boy made an uneventful recovery. This report is one of few in the literature describing isolated injury to the cisterna chyli after blunt abdominal trauma.     

Intrahepatic bile duct rupture following blunt abdominal trauma

The natural history of intrahepatic bile duct rupture secondary to blunt trauma is not known. A unique case of bilateral hepatic lobar duct rupture is presented to demonstrate the clinical features and potential complications of this injury. Operative intervention is not always indicated and treatment should be dictated by the specific lesion.     

Acute diaphragmatic rupture due to blunt trauma: a retrospective analysis

Twenty-eight cases of diaphragmatic rupture due to blunt trauma are reviewed. The need for accurate and rapid diagnosis and results of treatment are discussed. Chest roentgenogram was found to be the best diagnostic aid. Surgical repair through an abdominal approach is advised in all acute cases. The high mortality rate in this series (28.6%) is related to the multiple injuries rather than to the diaphragmatic lesion itself.     

Pancreatic rupture following a bull-head caused blunt abdominal trauma

A 33-year-old man was admitted to our hospital with clinical and instrumental-diagnostic evidence (CT) of haemoperitoneum following a blunt abdominal trauma due to being butted by a bull. A full-thickness rupture of the pancreas, at the level of the isthmus, was found at laparotomy. The emergency procedure consisted in evacuation of the haemoperitoneum, haemostasis and suture of the pancreatic lesion plus drainage of the lesser sac. A high-output (800 ml/day) post-traumatic pancreatic fistula developed in the following days, with the need for a second operation. In the presence of a large pancreatic defect extensively communicating with the Wirsung duct, a singular surgical procedure was adopted in the form of a Roux-en-Y pancreaticojejunostomy with catheterisation of the pancreatic fistula using a small disposable silicone catheter. The post-operative course was uneventful and healing of the pancreatic fistula was documented at CT scan 39 days after the operation.     

Pneumoperitoneum resulting from tracheal rupture following blunt chest trauma

Pneumoperitoneum usually implies perforation of the gastrointestinal tract, although the tracheobronchial tree has been recognized as a source for free intraperitoneal air. We report a case of pneumoperitoneum resulting from tracheobronchial rupture following blunt chest trauma, which was successfully treated by surgical repair.