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DOI: 10.1055/s-0032-1333136
Late Consequences of Traumatic Rupture of the Diaphragm
Publication History
30 July 2012
12 November 2012
Publication Date:
23 January 2013 (online)
![](https://www.thieme-connect.de/media/thoracic/201303/lookinside/thumbnails/10.1055-s-0032-1333136-1.jpg)
Abstract
A 54-year-old man was admitted to our clinic due to elevated γ-glutamyltransferase, without any clinical symptoms. About 25 years ago, he had undergone blunt abdominal and thoracic trauma during an accident. No diagnostic measures or therapy had been performed at that time. Serum bilirubin was normal, but the values for alanine transaminase, aspartate transaminase, and alkaline phosphatase were slightly above the reference range. Sonography of the abdomen revealed dilated intrahepatic bile ducts up to 3 mm in diameter and steatosis of the liver grade I. CT scan and MRI of the thorax and abdomen showed a giant hiatal hernia with transposition of upper abdominal organs into the chest. As the patient presented clinically completely asymptomatic, without dyspnea, dysfunction of phonation or ingestion, we decided a conservative treatment with Ursodesoxycholic acid. The liver values resolved with this regimen gradually. At follow-up examination 1 year later, they had normalized. Spirometry showed a reduced lung capacity (3.44 L; 64.4% of the desired value) and a reduced FEV1 (forced expiratory volume in one second) of 2.84 L (70.2% of the desired value). Further diagnostics revealed normal otorhinolaryngological and phoniatric findings including stroboscopy of the vocal folds and voice range profile.
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References
- 1 Rashid F, Chakrabarty MM, Singh R, Iftikhar SY. A review on delayed presentation of diaphragmatic rupture. World J Emerg Surg 2009; 4: 32
- 2 Desir A, Ghaye B. CT of blunt diaphragmatic rupture. Radiographics 2012; 32 (2) 477-498
- 3 Dean C, Etienne D, Carpentier B, Gielecki J, Tubbs RS, Loukas M. Hiatal hernias. Surg Radiol Anat 2012; 34 (4) 291-299
- 4 Mitiek MO, Andrade RS. Giant hiatal hernia. Ann Thorac Surg 2010; 89 (6) S2168-S2173
- 5 Kehdy F. Current management of paraesophageal hernia. Am Surg 2011; 77 (12) 1565-1573
- 6 Skinner DB, Belsey RH. Surgical management of esophageal reflux and hiatus hernia. Long-term results with 1,030 patients. J Thorac Cardiovasc Surg 1967; 53 (1) 33-54
- 7 Hill LD. Incarcerated paraesophageal hernia. A surgical emergency. Am J Surg 1973; 126 (2) 286-291
- 8 Maziak DE, Todd TR, Pearson FG. Massive hiatus hernia: evaluation and surgical management. J Thorac Cardiovasc Surg 1998; 115 (1) 53-60 , discussion 61–62
- 9 Patel HJ, Tan BB, Yee J, Orringer MB, Iannettoni MD. A 25-year experience with open primary transthoracic repair of paraesophageal hiatal hernia. J Thorac Cardiovasc Surg 2004; 127 (3) 843-849
- 10 Luketich JD, Nason KS, Christie NA , et al. Outcomes after a decade of laparoscopic giant paraesophageal hernia repair. J Thorac Cardiovasc Surg 2010; 139 (2) 395-404 , e1
- 11 Antoniou SA, Koch OO, Antoniou GA, Pointner R, Granderath FA. Mesh-reinforced hiatal hernia repair: a review on the effect on postoperative dysphagia and recurrence. Langenbecks Arch Surg 2012; 397 (1) 19-27
- 12 Stylopoulos N, Gazelle GS, Rattner DW. Paraesophageal hernias: operation or observation?. Ann Surg 2002; 236 (4) 492-500 , discussion 500–501