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. 2019 Aug 28;19(1):123.
doi: 10.1186/s12893-019-0581-x.

Diagnosis and management of a trapped lung or diaphragm by fractured ribs: analysis of patients undergoing rib fracture repair

Ying-Hao Su  1 , Shun-Mao Yang  2 , Huan-Jang Ko  3
Affiliations

Diagnosis and management of a trapped lung or diaphragm by fractured ribs: analysis of patients undergoing rib fracture repair

Ying-Hao Su et al. BMC Surg. .

Abstract

Background: There are few reports regarding a lung or diaphragm trapped by a fractured rib. This study aimed to describe the clinical presentations, diagnosis, and management of these intrathoracic pathologies.

Methods: We retrospectively reviewed the database at our institute for patients with rib fractures who underwent thoracoscope-assisted surgical stabilization of rib fracture (SSRF). We analyzed the demographic data, mechanism of trauma, presentations, operative findings, and subsequent management strategies.

Results: A total of 38 consecutive patients who underwent SSRF were analyzed. Three patients had a trapped lung and one had a trapped diaphragm. Abnormal radiographic findings were observed in 50% of cases. The median waiting time for surgery was 25 days. Surgery was indicated for intractable dynamic pain following conservative treatment. A definitive diagnosis was made during thoracoscopic exploration. Thoracoscopic repair and resection were used for trapped lungs and thoracoscopic release for a trapped diaphragm. We subsequently performed SSRF for unhealed rib fractures.

Conclusion: As per our analysis, the incidence of a trapped lung or diaphragm was 10.5%. If a patient presents with persistent intractable dynamic pain, thoracoscopic exploration with concurrent SSRF may be a feasible and effective treatment option.

Keywords: Rib fracture; Surgical stabilization of rib fracture; Trapped diaphragm; Trapped lung.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Thoracoscopic exploration shows the lung parenchyma trapped by the fractured left 6th rib (a). Gentle dissection was attempted, but it was obstructed by the fractured rib and increased oozing (b). Repair and resection was performed with endoscopic linear cutter stapler (c). The trapped parenchyma was released (d)
Fig. 2
Fig. 2
Thoracoscopic exploration shows the left diaphragm trapped by the fractured left 9th and 10th ribs (a). The trapped diaphragm was released by electrocautery along the inner cortices of the ribs (b). A defect was noted after the release of the trapped diaphragm (denoted by the asterisk) (c). The defect was repaired with 3–0 Prolene sutures (d)
Fig. 3
Fig. 3
Computed tomography (CT) scan of the chest reveals lung atelectasis with intercostal extension of the lung parenchyma (arrow) secondary to being trapped by the left 6th rib
Fig. 4
Fig. 4
Computed tomography (CT) scan of the chest of Case no. 3 reveals normal dome shape of the right posterior diaphragm (a). Contralateral sagittal reconstruction of the CT scan of the chest reveals loss of the dome shape and altered contours of the left posterior diaphragm secondary to being trapped by the fractured left 9th and 10th ribs (b)
See this image and copyright information in PMC

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