Sánchez-Lozada R, Ortiz-González J, Vega CGR

Language: Spanish
References: 12
Page: 162-166
PDF size: 302.91 Kb.

ABSTRACT

Objective: Report a gastric strangulation secondary to diaphragmatic traumatic hernia. Introduction: The diaphragmatic rupture happens in 5% of the patients with trauma toracoabdominal severe and the herniation of abdominal viscera to thorax it happens in the 45 to 60% of the cases. The stomach is the organ more frequent. The gastric strangulation is a strange complication. Clinical case: Patient masculine of 57 years with trauma toracooabdominal severe of 3 days of evolution. Goes to the hospital with severe breathing difficulty. Diagnosticated diaphragmatic hernia and is carried out laparotomy. We find necrosis of the bottom and the gastric body for the herniation, drying up this segments. Before the doubt on the viability of the portion distal of the esophagus and proximal of the stomach is differed 12 hours the anastomosis. Presented in the postoperative a gastrocutaneous fistula with responded to the medical and surgical handling. Conclusions: The diagnosis of herniation gastric by diaphragmatic traumatic hernia can not realizated if the clinical suspicion doesn’t exist. The radiographics studies constitutes a good auxiliary diagnosis. The handling of the gastric strangulation not this exempt of morbility. As measure for reduced suggest the total gastrectomy in the select cases, with primary anastomosis.

REFERENCES

1. Shapiro MJ, Heiberg E, Durham RM. The unreliability of CT scans and initial chest radiographs in evaluating blunt trauma induced diaphragmatic rupture. Clin radiol 1996; 51: 27-30.

2. Shan R, Sabanathan S, Mearns AJ, Choudhury AK. Traumatic rupture of diaphragm. Ann Thorac Surg 1995; 60: 1444-1449.

3. Gelman R, Mirvis SE, Gens D. Diaphragmatic rupture due to blunt trauma: Sensivity of plain chest radiographs. AJR 1991; 156: 51-57.

4. Lee WC, Chen RJ, Fang JF, Wang CC. Rupture of the diaphragm after blunt trauma. Eur J Surg 1994; 160: 479-483.

5. Kingnorth AN, Gunning J. An unusual complication of traumatic diaphragmatic hernia. Thorax 1979; 34: 125-126.

6. Boulanger BR, Morvis SE, Rodríguez A. Magnetic resonance imaging in traumatic diaphragmatic rupture: case reports. J Trauma 1992; 1: 89-93.

7. Phillips PJ, Mattews MR, Caruso DM, Kassir AA, Gregory MW, Simpson T. Tension colothorax: A pleural effusion? J Trauma 1998; 44(6): 1091-1093.

8. Beal SL, McKennon M. Blunt diaphragm rupture - a morbid injury. Arch Surg 1988; 128: 828-831.

9. Meyers BF, McCabe CJ. Traumatic diaphragm hernia: Occult marker of serious injury. Ann Surg 1993; 6: 783-790.

10. Desforges G, Strieder JW, Lynch JP. Traumatic rupture of diaphragm. J Thorac Surg 1957; 34: 779-782.

11. Hopkins BR. Gastrofin as an aid to the early diagnosis of ruptured diaphragm following blunt thoracoabdominal trauma. Injury 1971; 3: 101-102.

12. Hsu CP, Chen CY, Hsieh YH, Hsia JY, Shai SE, Kao CH. Esophageal reflux after total or proximal gastrectomy in patients with adenocarcinoma of the gastric cardia. Am J Gastroenterol 1997; 92 (8): 1347-1350.