Thirteen Years' Experience of Diaphragmatic Injury in Children from the Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, India

Abstract

Background: Diaphragmatic hernia is migration of abdominal viscera into the thoracic cavity through a defect in the diaphragm. In children, it is mostly congenital; traumatic diaphragmatic hernia being less common. This study aimed to review our experience with traumatic diaphragmatic rupture (TDR) and to identify the clinical findings and diagnostic modality that may help in early diagnosis and prompt therapy.

Methods: The study involved 11 children (1-18 years old) with TDR who were hospitalised between 1993 and 2005. In addition to clinical examination, a plain X-ray of the chest and abdomen, an ultrasound, barium studies, and a computerised tomography (CT) scan were used to evaluate the patients.

Results: All of the diaphragmatic ruptures occurred on the left side, with 10 occurring in the posterolateral part and 1 near the oesophageal hiatus. Two of our patients presented 7 and 10 days after the injury, and 1 patient presented 1 year after the trauma.

Conclusion: TDR should remain a diagnostic possibility in children. These patients are best assessed using a CT scan. New research on stem cells and tissue-engineered bioprosthetics may pave the path for better future therapies in these cases.

Keywords: acute respiratory distress syndrome; child; diagnosis; diaphragmatic hernia; medical imaging; rupture; trauma.

Figure 1:

Chest X-ray (posteroanterior view) showing a cystic structure with an air-fluid level occupying the left haemithorax, causing collapse of the left lung and a slight mediastinal shift towards the right. The left haemidiaphragm is not well outlined (herniating stomach mimicking hydropneumothorax).

Figure 2:

Axial noncontrast computerised tomography scan of the lower chest showing a herniated stomach in the left thoracic cavity in an 8-year-old boy (arrow).