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28.10.2022 | case report

Thoracoabdominal approach for traumatic diaphragmatic hernia in a hemodynamically unstable patient

verfasst von: MD Mujtaba Mubashir, MD John O Barron, MD Hadika Mubashir, MD Alexander DeMare, MD PhD Siva Raja, MD PhD Sudish Murthy, MD Dean P. Schraufnagel

Erschienen in: European Surgery

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Summary

Background

Diaphragmatic hernias with strangulated contents are a surgical challenge. Thoracoabdominal incisions are commonly used for a variety of thoracic and vascular cases, although rarely used for diaphragmatic hernias, which are typically repaired with laparotomy, thoracotomy, or minimally invasive approaches.

Case report

We present the unique case of a 60-year-old, critically ill unstable patient with severe heart failure with a reduced ejection fraction (15–25%) and severe valve disease presenting with a left-sided diaphragmatic hernia containing strangulated small intestine and requiring urgent surgical exploration. This was safely and efficiently repaired via a thoracoabdominal approach at the index surgery, with intestines left in discontinuity and placement of temporary chest and abdominal closure. At the second planned operation, good continuity was successfully restored.

Results

The patient had early extubation, gradual diet advancement with full recovery, and discharge home on postoperative day 17.

Conclusion

A thoracoabdominal incision can safely be used in large strangulated diaphragmatic hernias, including in critically unstable patients. This approach provides rapid access to both the chest and abdomen with excellent, speedy, and safe exposure, which can save a life in extreme conditions.
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Metadaten
Titel
Thoracoabdominal approach for traumatic diaphragmatic hernia in a hemodynamically unstable patient
verfasst von
MD Mujtaba Mubashir
MD John O Barron
MD Hadika Mubashir
MD Alexander DeMare
MD PhD Siva Raja
MD PhD Sudish Murthy
MD Dean P. Schraufnagel
Publikationsdatum
28.10.2022
Verlag
Springer Vienna
Erschienen in
European Surgery
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-022-00782-8