Revista de Ciencias de la Salud
antecedentes personales, pues eso puede dar la pista que ayude al diagnóstico y tratamiento
temprano.
Palabras clave: Hernia diafragmática traumática crónica; complicaciones; trauma cerrado de
tórax.
Introduction
Diaphragmatic hernias are defined as the passage of the abdominal contents into the thoracic
cavity through a defect in the diaphragm. These are divided into congenital (anterior or
Morgagni and posterolateral or Bochdalek) and acquired (traumatic). Of these, congenital
diaphragmatic hernias produce hypoplasia with pulmonary hypertension in the new born,
which causes physiological alterations that seriously threaten life. The diagnosis
a
diaphragmatic hernia can be performed from the prenatal stage through different imaging
techniques. Bochdalek described in 1848 the embryology of
a diaphragmatic hernia that
today bears his name. A Bochdalek hernia is a congenital posterolateral defect of the
diaphragm located on the left side in 70 to 90 % of the cases. It is usually present with acute
respiratory failure
1
.
The incidence of traumatic
diaphragmatic hernia is uncommon, ranging from 0.8 to 8.0 % and
the mortality rate varies between 16 and 33 % according to the time of diagnosis, thus, the
faster the diagnosis is made, the lower the range of morbi mortality. There have been reports
of traumatic lesions of the diaphragm not detected appropriately, which remain asymptomatic
until it is accompanied by complications
2
.
The urgency of the diagnosis arises from cases of intestinal strangulation, volvulus or
compromise of organs or situations that affect the venous return and cardiac output by the
compression of the intrathoracic intestinal loops or by the great gastric distension with
hemodynamic or respiratory problems that they are observed in the evolution course of the
disease
3
. In hemodynamically stable patients, video laparoscopy and video thoracoscopy
allow the diagnosis and in many cases the treatment of the diaphragmatic lesion. In most
cases, the suture of the borders of the diaphragmatic wound is sufficient to correct the lesion.
In large diaphragmatic defects the use of prostheses may be necessary
4
.
With the aim of describing the main clinical manifestations of diaphragmatic hernia, its
approach and diagnosis, we present the case of a patient with a record of multiple traumas
due to traffic accidents, in which left diaphragmatic hernia was diagnosed incidentally.
Emphasis is placed on the most important aspects of this disease and the evolution that the
patient had.
Presentation of the case
A 52-year-old male, mestizo race, with a record of three previous traffic accidents (fracture of
right tibia and clavicle); who comes to our health home after suffering a traffic accident: he was
riding a motorcycle and was hit hard on the left leg by a car. At the time of admission he was
stable, afebrile, manifesting intense pain in the left leg and functional impotence.
Qhalikay. Revista de Ciencias de la Salud 3 (2017) 104-113
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