Hernia diafragmática incarcerada posterior a traumapenetrante de tórax, apropósito de un caso

Abstract

Diaphragmatic hernia is defined as the translocation of abdominal organs into the rib cage through a solution of continuity in the diaphragm, diaphragmatic injuries occur by high energy trauma that can be both closed and penetrating, among the main causes are traffic accidents. It has been established that it is an uncommon pathology, which has been increasing in recent times along with the increase of accidents on the roads around the world; it has also been determined that the main affected are middle-aged men, being the left side of the diaphragm the most common site of injury. Diaphragmatic rupture is rarely recognized in the initial assessment of polytraumatized patients, so it is usually silent and presents complications some time after the trauma, diaphragmatic herniation does not present a clear symptomatology, being pain due to ischemia or symptomatology related to the limitation of physical space in the thorax the main registered indicators of this clinical entity, so the diagnosis is based on the history of a high intensity trauma together with the realization of imaging tests that allow the determination of the specific site of injury and evidence of hernia. The most commonly used study is the supine chest X-ray, which despite being a simple method can achieve the recognition of the pathology, in addition to its low cost and accessibility. However, more sophisticated methods such as computed tomography can be used. The management of diaphragmatic hernia is surgical and the approach technique used will be determined by the individualized evaluation of each patient, as well as the time of evolution of this. This requires skilled and trained personnel to avoid recurrence of the herniation.