Thoracoabdominal approach for traumatic diaphragmatic hernia in a hemodynamically unstable patient

Springer Science and Business Media LLC - Tập 54 - Trang 331-334 - 2022
Mujtaba Mubashir1, John O Barron1, Hadika Mubashir1, Alexander DeMare2, Siva Raja1, Sudish Murthy1, Dean P. Schraufnagel1
1Department of Thoracic and Cardiothoracic Surgery, Cleveland Clinic Foundation, Cleveland, USA
2Department of General Surgery, Cleveland Clinic Foundation, Cleveland, USA

Tóm tắt

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

Tài liệu tham khảo

Gu P, Lu Y, Li X, Lin X. Acute and chronic traumatic diaphragmatic hernia: 10 years’ experience. PLoS ONE. 2019;14(12):e226364. Qureshi SS, Patil VP. Feasibility and safety of thoracoabdominal approach in children for resection of upper abdominal neuroblastoma. J Pediatr Surg. 2012;47(4):694–9. Kumar S, Duque JL, Guimaraes KC, Dicanzio J, Loughlin KR, Richie JP. Short and long-term morbidity of thoracoabdominal incision for nephrectomy: a comparison with the flank approach. J Urol. 1999;162(6):1927–9. Kishore GSB, Gupta V, Doley RP, et al. Traumatic diaphragmatic hernia: tertiary centre experience. Hernia. 2010;14(2):159–64.