Diaphragm rupture surgery

This is an automatically translated article.

The article was professionally consulted with resident Doctor Le Thanh Tuan - Gastroenterologist - General Surgery Department - Vinmec Nha Trang International General Hospital.
Diaphragmatic rupture is an uncommon injury in blunt abdominal trauma. Once a diaphragmatic rupture has been diagnosed, surgery should be performed to repair the rupture.

1. Traumatic rupture of the diaphragm

The diaphragm plays a very important role in the respiratory function of the body, if an injury occurs, it will weaken the functioning of the respiratory system.
Diaphragm rupture can be seen in closed abdominal trauma due to traffic accidents, abdominal wounds caused by stabbing knives, bullets. Diaphragm rupture is an injury to the integrity of the diaphragm, usually a severe trauma that causes the intra-abdominal pressure to rise suddenly, the diaphragm is stretched and ruptured. Rupture of the left diaphragm is common, but the right diaphragm is less likely to rupture due to the protection of the liver.
Through the rupture of the diaphragm, the viscera in the abdomen can enter the chest immediately after the injury or after the trauma for a while, causing a diaphragmatic hernia. Diaphragm rupture is often caused by an injury, so it is often accompanied by many other injuries in the abdomen and thorax, making diagnosis and treatment difficult.

2. Indications for surgery to suture ruptured diaphragm

Diaphragm suture surgery is indicated for cases where the diaphragm is perforated, torn, broken due to trauma, penetrating abdominal wound, after complications of other surgery.

3. Perform surgery to suture the rupture of the diaphragm

Before surgery, the patient will be performed basic tests such as blood count, biochemistry, chest x-ray. After that, an intravenous line is placed, a gastric tube is placed, a bladder tube is placed.
Technician conducts general anesthesia, intubation

The surgeon opens the white line above the umbilicus, when necessary, can extend it below the navel or open more horizontal lines to the right if it is necessary to handle the accompanying right liver injury. Laparoscopic surgery may be used depending on the surgeon's assessment of the injury. Examination of the abdomen: Abdominal fluid: Observe and evaluate the color, nature of the peritoneal fluid, determine the blood fluid, digestive fluid or bile, pus, urine ... the amount of fluid, when the blood fluid is abundant means that the lesion is large, it is necessary to quickly determine the extent of the damage commensurate with the upper layer of the transverse mesocolon: The surgeon evaluates the liver, spleen, omentum omentum, body, and tail of the pancreas Lower layer of the mesenteric colon Horizontal: Assess the transverse colon, the first part of the small intestine, observe along the two colonic grooves, aspirate to evaluate the ascending and descending colon, sigmoid. Also examine the small intestine and mesentery from the ileocecal angle upwards. Evaluation of bladder, retroperitoneal hematoma, uterus, adnexa (in female patients) Treatment of diaphragmatic injury: With herniated viscera: Need to return the viscera to the abdomen, treatment depends on tissue vitality herniated organ. The surgeon examines the pleural cavity, the ipsilateral lung through the rupture of the diaphragm, treats damage to the lung parenchyma, washes the pleura if there is purulent fluid, digestive juices, pseudomembranous membranes, blood clots. Place a pleural drainage on the same side of the lesion as the V intercostal space, mid-axillary line. Expose wound edge of diaphragm, excision. Stitch the diaphragm with a single layer of squeegee or a loose stitch with non-absorbable thread. Place drainage depending on the location of the diaphragm and the affected organs.

4. Treatment of complications after surgery to suture the rupture of the diaphragm

Follow-up after surgery: After surgery, the patient is treated with antibiotics for 5-7 days Continue to monitor fluid and air through pleural drainage, abdominal drainage Complications and management: Before and during surgery there are may experience septic shock, respiratory failure, cardiac tamponade due to late diagnosis. Treatment is by limiting the patient's position change, quickly releasing the pleural space, if necessary, by placing a pleural drainage first, coordinating with the anesthesiologist to perform surgery and resuscitation.
After surgery, there may be some complications such as:
Air leak, pleural bleeding: Treatment depends on the amount of blood and air out, Gastrointestinal leak: When the leak is small, follow up with internal treatment Massive fistula, intra-abdominal abscess, peritonitis: It is necessary to carry out surgery to re-evaluate organ damage, treatment depends on the nature and extent of damage Vinmec International General Hospital is one of the hospitals. not only ensure professional quality with a team of doctors, modern equipment and technology, but also stand out with comprehensive and professional medical examination, consultation and treatment services; civilized, polite, safe and sterile medical examination and treatment space.

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