REVISIÓN DEL TEMA

 

HERNIAS DIAFRAGMÁTICAS: DESAFÍO CLÍNICO Y QUIRÚRGICO

 

VOLUMEN 24 No. 2 ABRIL - JUNIO 2009

 

 Haga su consulta por tema

 

 

Diaphragmatic hernias: a clinical and surgical challenge

 

Abstract

 

Diaphragmatic hernias are defined as the passage of abdominal contents into the thoracic cavity through a diaphragmatic anatomical defect. They are classified as congenital (anterior or Morgani´s), posterolateral (or Bochadalek´s), and acquired (traumatic).

 

Congenital diaphragmatic hernias produce pulmonary hypoplasia and pulmonary hypertension in the newborn, which are associated with life-threatening physiologic complications. Prenatal diagnosis can be established trough different imaging techniques. Treatment includes respiratory stabilization of the newborn, followed by surgical repair of the anatomic defect.

 

Traumatic diaphragmatic hernias result from blunt or penetrating trauma. Penetrating trauma over the thoracoabdominal region is the most common cause. Sensibility of diagnostic images is not high, a fact that interferes with diagnosis. However, laparoscopy and thoracoscopy yield better diagnostic accuracy and also constitute a treatment approach. Surgical correction, by the abdominal or the thoracic approach, has to be performed as soon as diagnosis is established.

 

Key words: diaphragm; hernia, diaphragmatic; thoracic injuries; thoracic surgery; thoracic surgery, videoassisted.

 

Referencias

 

1. SADLER TW. Cavidades corporales. En: Langman. Embriología médica con orientación clínica. 8ª edición. Buenos Aires: Editorial Médica Panamericana; 2001;191-200.

 

2. SCHUMPELICK V, STEINAU G, SCHLÜPER I, PRESCHER A. Surgicalembryology and anatomy of the diaphragm with surgicalapplications. Surg Clin North Am. 2000;80:213-39.

 

3. LATARJET M, RUIZ LIARD A. En: Latarjet M, Ruiz Liard A, editor. Anatomía humana. 3ª edición. Madrid: Editorial Médica Panamericana; 1999;988-99.

 

4. BONETUS T. Sepulchretum, sive anatomía practica ex cadaveribus morbo denatis. Genevae: L Chouet; 1679.

 

5. MORGAGNI GB. Seats and causes of disease investigated by anatomy. London: Miller and Cadell; 1769;205.

 

6. BOCHDALEK VA. Einige betrachtungen uber die entstehung des angeborenen zwerchfellbruches: als beitrag zur pathologischen anatomie der hernien. Vierteljahrsschrift fur die Praktische Heilkunde. 1848;19:89.

 

7. HOWE DT, KILBY MD, SIRRY H, BARKER GM, ROBERTS E, DAVIDSON EV, et al. Structural chromosome anomalies in congenital diaphragmatic hernia. Prenat Diagn. 1996;16:1003-9.

 

8. ROBINSON PD, FITZGERALD DA. Congenital diaphragmatic hernia. Paediatr Respir Rev. 2007;8:323-34.

 

9. DOWNARD CD. Congenital diaphragmatic hernia: an ongoing clinical challenge. Curr Opin Pediatr. 2008;20:300-4.

 

10. BUTLER N, CLAIRVEAUX AE. Congenital diaphragmatic hernia as a cause of perinatal mortality. Lancet. 1962;1:659-63.

 

11. FAUZA DO, WILSON JM. Congenital diaphragmatic hernia and associated anomalies: their incidence, identification, and impact on prognosis. J Pediatr Surg. 1994;29:1113-7.

 

12. GRAZIANO JN, Congenital Diaphragmatic Hernia Study Group.  Cardiac anomalies in patients with congenital diaphragmatic hernia and their prognosis: a report from the Congenital Diaphragmatic Hernia Study Group. J Pediatr Surg. 2005;40:1045-9.

 

13. ADZICK NS, HARRISON MR, GLICK PL, NAKAYAMA DK, MANNING FA, DELORIMIER AA. Diaphragmatic hernia in the fetus: prenatal diagnosis and outcome in 94 cases. J Pediatr Surg. 1985;20:357-61.

 

14. WILSON JM, LUND DP, LILLEHEI CW, VACANTI JP. Congenital  diaphragmatic hernia –A tale of two cities: The Boston experience. J Pediatr Surg. 1997;32:401-5.

 

15. LANGER JC, FILLER RM, BOHN DJ, SHANDLING B, EIN SH, WESSON DE, et al. Timing of surgery for congenital diaphragmatic hernia: Is emergency operation necessary? J Pediatr Surg. 1988;23:731-4.

 

16. HARRISON MR, LANGER JC, ADZICK NS, GOLBUS MS, FILLY RA, ANDERSON RL, et al. Correction of congenital diaphragmatic hernia in utero. V. Initial clinical experience. J Pediatr Surg. 1990;25:47-55.

 

17. HARRISON MR, KELLER RL, HAWGOOD SB, KITTERMAN JA, SANDBER PL, FARMER DL, et al. A randomized trial of fetal endoscopic tracheal occlusion for severe fetal congenital diaphragmatic hernia. N Engl J Med. 2003;349:1916-24.

 

18. HARDESTY RL, GRIFFITH BP, DEBSKI RF, JEFFRIES MR, BOROVETZ HS. Extracorporeal membrane oxygenation. Successful treatment of persistent fetal circulation following repair of congenital diaphragmatic hernia. J Thorac Cardiovasc Surg. 1981;81:556-63.

 

19. BREAUX CW JR, ROUSE TM, CAIN WS, GEORGESON KE. Improvement in survival of patients with congenital diaphragmatic hernia utilizing a strategy of delayed repair after medical and/or extracorporeal membrane oxygenation stabilization. J Pediatr Surg. 1991;26:333-6.

 

20. GLICK PL, LEACH CL, BESNER GE, EGAN EA, MORIN FC, MALANOWSKA-KANTOCH A, et al. Pathophysiology of congenital diaphragmatic hernia. III: Exogenous surfactant therapy for the high-risk neonate with CDH. J Pediatr Surg. 1992;27:866-9.

 

21. KLUTH D, BÜHRER, NESTORIS S, TANDER B, WERNER C, LAMBRECHT W. Inhaled nitric oxide increases survival rates in newborn rats with congenital diaphragmatic hernia. Eur J Pediatr Surg. 1997;7:90-2.

 

22. HARRIS K. Extralobar sequestration with congenital diaphragmatic hernia: a complicated case study. Neonatal Netw. 2004;23:7-24.

 

23. STEGE G, FENTON A, JAFFRAY B. Nihilism in the 1990s: the true mortality of congenital diaphragmatic hernia. Pediatrics. 2003;112:532-5.

 

24. CLARK RH, HARDIN WD JR, HIRSCHL RB, JAKSIC T, LALLY KP, LANGHAM MR Jr, et al. Current surgical management of congenital diaphragmatic hernia: A report from the Congenital Diaphragmatic Hernia Study Group. J Pediatr Surg. 1998;33:1004-9.

 

25. SCHNEIDER CF. Traumatic diaphragmatic hernia. Am J Surg. 1956;91:290-7.

 

26. HANBY WB. The case reports and autopsy records of Ambroise Pare. Springfield, IL: Thomas; 1968. p. 50-1.

 

27. HEDBLOM CA. Diaphragmatic hernia. JAMA. 1925;85:947.

 

28. CARTER BN, GIUSEFFI J, FELSON B. Traumatic diaphragmatic hernia. Am J Roentgenol Radium Ther Nucl Med. 1951;65:56-72.

 

29. HOOD RM. Traumatic diaphragmatic hernia. Ann Thorac Surg. 1971;12:311-24.

 

30. SHAH R, SABANATHAN S, MEARNS AJ, CHOUDHURY AK. Traumatic rupture of diaphragm. Ann Thorac Surg. 1995;60:1444-9.

 

31. SHARMA O. Pericardio-diaphragmatic rupture: five new cases and literature review. J Emerg Med. 1999;17:963-8.

 

32. SCHARFF JR, NAUNHEIM KS. Traumatic diaphragmatic injuries. Thorac Surg Clin. 2007;17:81-5.

 

33. TAPIAS L, REY M. Trauma de tórax. Médicas UIS. 1997;11:210-3.

 

34. WARD RE, FLYNN TC, CLARK WP. Diaphragmatic disruption  secondary to blunt abdominal trauma. J Trauma. 1981;21:35-8.

 

35. ZANTUT LF, IVATURY RR, SMITH RS, KAWAHARA NT, PORTER JM, FRY W, et al. Diagnostic and therapeutic laparoscopy for penetrating abdominal trauma: A multicenter experience. J Trauma. 1997;42:825-9.

 

36. TROOP B, MYERS RM, AGARWAL N. Early recognition of diaphragmatic injuries from blunt trauma. Ann Emerg Med. 1985;14:97-101.

 

37. MOORE JB, MOORE EE, THOMPSON JE. Abdominal injuries in association with penetrating trauma to the lower chest. Am J Surg. 1980;140:724-30.

 

38. JARRETT F, BERNHARDT LC. Right-sided diaphragmatic injury: rarity  or overlooked diagnosis? Arch Surg. 1978;113:737-9.

 

39. ALA KULJU K, VERKKALA K, KETONEN P, HARJOLA PT. Traumatic rupture of right hemidiaphragm. Scand J Thorac Cardiovasc Surg. 1986;20:109-14.

 

40. TAPIAS L, CALA H, GONZÁLEZ G, RODRÍGUEZ JD, OROZCO LC. Trauma de tórax. Guías de práctica clínica basadas en la evidencia. Bogotá: Proyecto ISS – Ascofame; 1997.

 

41. MILLIKAN JS, MOORE EE, STEINER E, ARAGON GE, VAN WAY CW. 3rd. Complications of tube thoracostomy for acute trauma. Am J Surg. 1980;140:738-41.

 

42. TAPIAS L, TAPIAS-VARGAS LF, TAPIAS-VARGAS L. Complicaciones de los tubos de tórax. Rev Colomb Cir. 2009;24:30-9.

 

43. ROSATI C. Acute traumatic injury of the diaphragm. Chest Surg Clin North Am. 1998;8:371-9.

 

44. GUTH AA, PACHTER HL, KIM U. Pitfalls in the diagnosis of blunt diaphragmatic injury. Am J Surg. 1995;170:5-9.

 

45. TRUONG S, GELLER H, STARKE J, SCHUMPELICK V. Stellenwert der Sonographie in der Diagnostik traumatischer Zwerchfellrupturen. Aktuelle Chirurgie. 1991;26:72.

 

46. PFANNSCHMIDT J, SEILER H, BOTTCHER H, KARADIAKOS N, NEISTERKAMP B. Zwerchfellrupturen: Diagnostik-Therapie- Ergebnisse. Aktuelle Traumatologie. 1994;24:48.

 

47. MURRAY JG, CAOILI E, GRUDEN JF, EVANS SJ, HALVORSEN RA JR, MACKERSIE RC. Acute rupture of the diaphragm due to blunt trauma: Diagnostic sensitivity and specificity of CT. AJR Am J Roentgenol. 1996;166:1035-9.

 

48. EREN S, CIRIº F. Diaphragmatic hernia: diagnostic approaches with review of the literature. Eur J Radiol. 2005;54:448-59.

 

49. LANG-LAZDUNSKI L, MOUROUX J, PONS F, GROSDIDIER G, MARTINOD E, ELKAIM D, et al.. Role of videothoracoscopy in chest trauma. Ann Thorac Surg. 1997;63:327-33.

 

50. KERN JA, TRIBBLE CG, SPOTNITZ WD, RODGERS BM, DANIEL TM. Thoracoscopy in the subacute management of patients with thoracoabdominal trauma. Chest. 1993;104:942-5.

 

51. URIBE RA, PACHÓN CE, FRAME SB, ENDERSON BL, ESCOBAR F, GARCÍA GA. A prospective evaluation of thoracoscopy for the diagnosis of penetrating thoracoabdominal trauma. J Trauma. 1994;37:650-4.

 

52. FREEMAN RK, AL-DOSSARI G, HUTCHESON KA, HUBER L, JESSEN ME, MEYER DM, et al. Indications for using video-assisted thoracoscopic surgery to diagnose diaphragmatic injuries after penetrating chest trauma. Ann Thorac Surg. 2001;72:342-7.

 

53. SMITH RS, FRY WR, MORABITO DJ, KOEHLER RH, ORGAN CH Jr. Therapeutic laparoscopy in trauma. Am J Surg. 1995;170:632-6.

 

54. FABIAN TC, CROCE MA, STEWART RM, PRITCHARD FE, MINARD G, KUDSK KA. A prospective analysis of diagnostic laparoscopy in trauma. Ann Surg. 1993;217:557-64.

 

55. HANNA WC, FERRI LE, FATA P, RAZEK T, MULDER DS. The current status of traumatic diaphragmatic injury: lessons learned from 105 patients over 13 years. Ann Thorac Surg. 2008;85:1044-8.

 

56. MORALES CH, VILLEGAS MI, ÁNGEL W, VÁSQUEZ JJ. Value of digital exploration for diagnosing injuries to the left side of the diaphragm caused by stab wounds. Arch Surg. 2001;136:1131-5.

 

57. MORALES CH. ¿Evita la toracoscopia la realización de toracotomías en el paciente con trauma de tórax? Panam J Trauma. 2004;11:13-20.

 

58. FLANCBAUM L, DAUBER M, DEMAS C, BOYARSKY AH, TROOSKIN SZ. Early diagnosis and treatment of blunt diaphragmatic injury. Am Surg. 1988;54:195-9.

 

59. LAU CL, MEYERS BF. The diaphragm. En: Kaiser LR, Kron IL, Spray TL. Mastery of cardiothoracic surgery. 2nd edition. Philadelphia: Lippincott Williams & Wilkins; 2006. p. 228-43.

 

60. LEE WC, CHEN RJ, FANG JF, WANG CC, CHEN HY, CHEN SC, et al. Rupture of the diaphragm after blunt trauma. Eur J Surg. 1994;160:479-83.

 

61. LAWS HL, HAWKINS ML. Diaphragmatic injury. In: Maull KI, Cleveland HC, Stauch GO, Wolferth CC. Advances in trauma. Chicago: Yearbook Medical Publishers Inc.; 1987. p.207-27.

 

62. HUSEMANN B, KNOCH M. Atiologie, diagnostik und therapie der traumatischen zwerchfellruptur. Chirurgische Praxis. 1987;37:233.

 

63. ZEREY M, HENIFORD BT, SING RF. Laparoscopic repair of traumatic diafragmatic hernia. Operative Techniques in General Surgery. 2006;8;27-33.

 

Correspondencia:

 

LEONIDAS TAPIAS, MD

Correo electrónico: leotapias@gmail.com

Bucaramanga, Colombia   

 

 

 

 

 

| Ver más Revistas | Revistas Médicas | Medicina |