Resumen

RUIZ-TOVAR, Jaime, CALERO GARCIA, Purificación, MORALES CASTINEIRAS, Vicente et al. Hernia diafragmática postraumática. Rev. gastroenterol. Perú, jul./set. 2008, vol.28, no.3, p.244-247. ISSN 1022-5129.

Postraumatic diaphragmatic hernias may occur after blunt or penetrating trauma. Due to coexisting injuries and the silent nature of the diaphragmatic lesions, the diagnosis can sometimes be missed in the acute phase and may present later on with obstructive symptoms due to incarcerated organs in the diaphragmatic defect. Material and Methods: We perform a retrospective study of all operated cases at our institution during the last 20 years. Results: 23 patients were included, 17 men and 6 women. 21 patients presented antecedents of blunt trauma and 2 of penetrating one. 7 patients were diagnosed in acute phase, manifesting as acute abdomen and hemodinamic instability. 13 patients were diagnosed in chronic phase, 4 of them with respiratory symptoms and 9 with bowel obstruction symptoms. 3 patients were asymptomatic and the diagnosis was an incidental finding. 12 patients underwent elective surgery and 11 emergency surgery, 7 of them in acute phase and 4 in chronic complicated one. Abdominal approach was performed in all the patients. Laparoscopic approach was unsuccessfully tried in one patient. The hernia was located in the left hemidiaphragm in 16 patiens, in the right one in 6 and in one case the defect was bilateral. Mesh was placed in only 2 cases. Intraoperative mortality appeared in one patient with acute diaphragmatic hernia due to coexisting hepatic lesions and morbidity appeared in only 1patients, presented as a respiratory sepsis. Conclusions: Postraumatic diaphragmatic hernia is a rare clinical entity of difficult diagnosis. In the chronic phase, there is a high risk of visceral strangulation or respiratory symptoms.

Palabras llave: Traumatic diaphragmatic hernia; Thorax-abdominal trauma; Blunt trauma; Penetrating trauma.