188宝金博页面版

BioMed CentralPage 1 of 7(page number not for citation purposes)World Journal of Emergency SurgeryOpen AccessReviewA review on delayed presentation of diaphragmatic ruptureFarhan Rashid* 1,2 , Mallicka M Chakrabarty 1,2 , Rajeev Singh 3 and Syed Y Iftikhar 1,2Address: 1 Division of GI Surgery, University of Nottingham, Graduate Entry Medical School, Uttoxeter Road, Derby, DE22 3DT, UK, 2 Department of Upper GI Surgery, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK and 3 Department of Radiology, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UKEmail: Farhan Rashid* - farhan_rashid@hotmail.com; Mallicka M Chakrabarty - mdzmc@exmail.nottingham.ac.uk; Rajeev Singh - rajeev.singh@derbyhospitals.nhs.uk; Syed Y Iftikhar - syed.iftikhar@btinternet.com* Corresponding author AbstractDiaphragmatic rupture is a life-threatening condition. Diaphragmatic injuries are quite uncommonand often result from either blunt or penetrating trauma. Diaphragmatic ruptures are usuallyassociated with abdominal trauma however, it can occur in isolation. Acute traumatic rupture ofthe diaphragm may go unnoticed and there is often a delay between the injury and the diagnosis. Acomprehensive literature search was performed using the terms "delayed presentation of posttraumatic diaphragmatic rupture" and "delayed diaphragmatic rupture". The diagnostic andmanagement challenges encountered are discussed, together with strategies for dealing with them.We have focussed on mechanism of injury, duration, presentation and site of injury, visceralherniation, investigations and different approaches for repair. We intend to stress on theimportance of delay in presentation of diaphragmatic rupture and to provide a review on theavailable investigations and treatment methods. The enclosed case report also emphasizes on thedelayed presentation, diagnostic challenges and the advantages of laparoscopic repair of delayeddiaphragmatic rupture.Review of LiteratureA Pubmed search was conducted using the terms "delayedpresentation of post traumatic diaphragmatic rupture"and "delayed diaphragmatic rupture". Although quite afew articles were cited, the details of presentation, investi-gations and treatment discussed in each of these were notidentical, accounting for the variation in the data pre-sented below.Late presentation of diaphragmatic rupture is often aresult of herniation of abdominal contents into the tho-rax[1]. Sudden increase in the intra abdominal pressuremay cause a diaphragmatic tear and visceral hernia-tion[2]. The incidence of diaphragmatic ruptures afterthoraco-abdominal traumas is 0.8–5% [3] and up to 30%diaphragmatic hernias present late[4]. Diaphragmatic,lumbar and extra-thoracic hernias are well described com-plications of blunt trauma [5]. Incorrect interpretation ofthe x ray or only intermittent hernial symptoms are fre-quent reasons for incorrect diagnosis[6].Mechanism of injuryDiaphragmatic rupture with abdominal organ herniationwas first described by Sennertus in 1541[7,8]. Diaphrag-matic injury is a recognised consequence of high velocityblunt and penetrating trauma to the abdomen and chestPublished: 21 August 2009World Journal of Emergency Surgery 2009, 4:32 doi:10.1186/1749-7922-4-32Received: 30 June 2009Accepted: 21 August 2009This article is available from: http://www.wjes.org/content/4/1/32© 2009 Rashid et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.