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Double Blow Injury: Left diaphragmatic eventration with colonic perforation following blunt trauma

Carlos Tadeo Perzabal Avilez, Cesar Alberto Lopez Jaime, Veronica Salais Michaus.

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This is a 35-year-old male patient who attended the emergency service after presenting assault by third parties 48 hours prior to admission with blunt objects. A chest radiograph was performed with evidence of a left pneumothorax and a radiolucent image in the left basal region. The patient goes to the operating room and under general anaesthesia, a diagnostic laparoscopy is started with evidence of traumatic left diaphragmatic eventration with stomach and colon, the content reduction is performed with evidence of transverse colon perforation and intestinal material in the thorax, thorough cleaning of the thoracic and abdominal cavity is performed, diaphragmatic closure left endopleural tube and terminal colostomy of the transverse colon is performed.
Blunt diaphragmatic lesions represent a relatively uncommon event, with an estimated prevalence of 0.2%-7% in patients admitted to an Emergency Department because of blunt trauma. The various mechanisms responsible for traumatic diaphragmatic hernia in blunt injuries include a rapid increase in intracavitary pressure or shearing forces on a stretched diaphragm or an avulsion mechanism from its attachment points. Left-sided ruptures are more often seen than right-sided ones (70– 80% vs. 15–24% cases). Surgical approaches, such as thoracotomy, laparotomy, and thoracotomy with laparotomy, are often used for the treatment of a diaphragmatic rupture. The overall mortality rate reported in the literature ranges from 4.3 to 37% in a series of penetrating and blunt injuries, respectively.
Diaphragmatic injuries due to blunt trauma are rare; require a high degree of suspicion from the physician and the performance of specific studies such as a thoracoabdominal computed tomography. Surgical management is necessary for all diaphragmatic lesions and can be performed laparoscopically.

Key words: Double blow injury, diaphragmatic eventration, colonic perforation, blunt trauma, laparoscopy

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