• Journal of Trauma and Injury
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• v.36 no.3
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• pp.258-260
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• 2023

Traumatic rupture of the right hemidiaphragm occurred following a high-velocity motor vehicle collision in the case presented herein. The resulting herniation of small bowel loops into the thorax resulted in hemodynamic and respiratory compromise due to pressure effects on the right heart and major vessels. The patient's hemodynamic status improved with reduction of enterothorax, and the diaphragmatic defect was repaired. We discuss the available literature and learning points from this rare case.

• Journal of Chest Surgery
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• v.20 no.3
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• pp.483-488
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• 1987

Phrenic nerve injury has been reported with the use of iced slush for topical cardiac hypothermia. A review of the preoperative and the postoperative chest roentgenograms was performed to detect phrenic nerve injury in patients undergoing cardiac operation with the use of iced slush for topical hypothermia from January, 1985 to June, 1987. The reviewed series included 45 patients who had undergone valve replacement. In this review, the injured site of phrenic nerve was left in 13 cases, right in 1 case and the overall incidence of phrenic nerve paralysis following open heart surgery was 31%. Compared to the incidence of phrenic nerve paralysis in the control group [without pericardial insulation] [406, 12 cases/30 cases], that in the group of patients receiving pericardial insulation [13.3%, 2 cases/15 cases] was lower, but there was no statistical significance. The initial time that diaphragmatic paralysis developed was mean 3.5 days [range 1-8 days] postoperatively and the recovery time of the paralysis was mean 4.7 months [range 0.5-10.5 months] postoperatively.

• Journal of Trauma and Injury
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• v.32 no.2
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• pp.122-125
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• 2019

A 73-year-old man, who, in an inebriated state, had slipped in a flowerbed and was wounded on the left flank, was transferred to Trauma Center, Gil Medical Center, Gachon University College of Medicine. Based on the chest and abdominopelvic computed tomography, he was diagnosed with multiple rib fractures and hemopneumothorax on the left hemithorax and was found to have a bony fragment in the spleen. He had not presented peritonitis and exsanguinous symptoms during the observation period. Seven days later, computed tomography of the abdomen showed suspected diaphragmatic injury and a retained foreign body in the spleen. On exploration by video assisted thoracoc surgery (VATS), a herniated omentum through the lacerated site of the diaphragm was observed. After omentectomy using Endo Gia, the foreign body in the spleen was observed through the lacerated site of the diaphragm. Traumatic diaphragm rupture with a foreign body, in the spleen, was successfully managed by video assisted thoracic surgery via the lacerated site of the diaphragm.

• Journal of Chest Surgery
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• v.30 no.5
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• pp.517-523
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• 1997

The records of 14 patients with traumatic diaphragmatic rupture seen at Dongguk University Hospital from February 1992 through December 1995 were reviewed. Ten patients were male and four were female(M:F=2.5:1). The age distribution ranged from 17 to 73 years with the mean age of 41.7 years. The 14 patients included 12 who had blunt trauma(traffic accident 11, crushing injury 1) and 2 with penetrating diaphragmatic rupture(stab wound 2). Of those 12 blunt trauma, 7 patients(58.3%) were left sided and 5(41.7%) involved the right hemidiaphragm. The diagnosis was made preoperatively in 8 patients (57.1%) and during surgery in 6(42.9%). All right-sided injuries were repaired through a thoracotomy and left-sided defects were corrected through a laparotomy in 6, laparotomy and thoracotomy in 1. There were 2(14.3%) operative deaths that were caused by myocardial infarction and the sequelae of combined injuries.

• Journal of Chest Surgery
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• v.29 no.4
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• pp.433-439
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• 1996

From January 1980 to July 1995, 32 patients with blunt diaphragmatic trauma and 12 wish penetrating diaphragmatic trauma were treated at Kyungpook University Hospital. The mean age of patients with blunt trauma was 37.6 years, and with penetrating trauma 29.2 years. The mean age was older in patients with blunt trauma by 8.4 years (p< 0.05). When simple chest X-ray diagnosis was performed, 24cases (75%) of the diaphragmatic injuries were found in blunt trauma and 4 case(33%) in penetrating trauma. When opei.ations were done due to injuries of thoracic or abdominal organ, 7 diaphragmatic injuries (58%) were found in penetrating trauma. Herniation occurred in 24 patients (75%) in blunt trauma and 5 patients (42%) in penetrating truma. The size of injured diaphragms in 29 cases in which hernia was discovered was 10.9 $\pm$ 4.3cm. On the other hand, the size in 15 cases in which hernia did not occur was 3.5 $\pm$ 2.9cm. There was a remarkable difference in their size depending on the presence or absence of hernia (p< 0.051. That is, a close relation between the sire of injured diaphragms and hernia was shown. All diaphragmatic injuries were repaired primarily. In blunt trauma approach of repair were as follows : 20 (63%) thoracic, 9 abdominal, 2 thoracoabdominal, and 1 thoracic and in penetrating trauma 6 (50%) abdominal, 4 thoracic, and 2 thoracic and abdominal. The complication rate was 19% in blunt trauma and 25% in penetrating trauma. Two patients with blunt trauma died with a mortality rate of 6.3% . All patients with penetrating trauma recovered. This study suggests that diaphragmatic injury should be suspected in all patients w th blunt as well as penetrating injury of the chest and abdomen. The size of injured diaphragms was larger in blunt trauma than in penetrating trauma. For herniation, it appeared to be more common in blunt trauma. The morbidity and mortality were related primary to the severity of associated injuries.

• Journal of Korean Neurosurgical Society
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• v.54 no.4
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• pp.359-362
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• 2013

Chronic hypoventilation due to injury to the brain stem respiratory center or high cervical cord (above the C3 level) can result in dependence to prolonged mechanical ventilation with tracheostomy, frequent nosocomial pneumonia, and prolonged hospitalization. Diaphragm pacing through electrical stimulation of the phrenic nerve is an established treatment for central hypoventilation syndrome. We performed chronic phrenic nerve stimulation for diaphragm pacing with the spinal cord stimulator for pain control in a quadriplegic patient with central apnea due to complete spinal cord injury at the level of C2 from cervical epidural hematoma. After diaphragmatic pacing, the patient who was completely dependent on the mechanical ventilator could ambulate up to three hours every day without aid of mechanical ventilation during the 12 months of follow-up. Diaphragm pacing through unilateral phrenic nerve stimulation with spinal cord stimulator was feasible in an apneic patient with complete quadriplegia who was completely dependent on mechanical ventilation. Diaphragm pacing with the spinal cord stimulator is feasible and effective for the treatment of the central hypoventilation syndrome.

• Journal of Trauma and Injury
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• v.35 no.1
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• pp.61-65
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• 2022

Traumatic abdominal wall hernia is a very rare clinical entity. Herein, we report the case of a patient who was transferred from a local clinic to the emergency department because of left lower abdominal pain. Initially, an intra-abdominal hematoma was observed on computed tomography and no extravasation was noted. Conservative treatment was initiated, and the patient's symptoms were slightly relieved. However, though abdominal pain was relieved during the hospital stay, bowel herniation was suspected in the left periumbilical area. Follow-up computed tomography showed traumatic abdominal wall hernia with hemoperitoneum in the abdomen. We performed a laparoscopic exploration of the injury site and hernia lesion. The anterior abdominal wall hernia was successfully closed.

• Journal of Chest Surgery
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• v.30 no.10
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• pp.1005-1009
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• 1997

Diaphragm injuries are very important because, if both thoracic and abdominal viscera are damaged, a combination of shock and acute respiratory distress may develop. It can be highly lethal. This evaluation was based on the reviews of 17 cases of traumatic diaphragm injuries treated at the Department of Cardiovascular Surgery, Seoul Adventist Hospital during 5 years from March 1993 to February 1997. The mean age of the patients was 37.2 years and sex ratio was 3.2:1 with male dominance. Blunt trauma(N=5, Rt.=4, Lt.= 1) was 29.5%, penetrating trauma(N= 12, Rt.=5, Lt.=7) was 70.5%. Dyspnea(76%) was the most common symptom. Blunt trauma(9.8$\pm$3.7 Cm) was larger than the penetrating trauma(3.2$\pm$ 1.3 Cm)(P<0.05) in the size(mean$\pm$SD) of the injury. All of the patients had associated injuries and repaired immediatley with thoracic approach 11 cases(64%), abdominal approaih 3 cases(18%) and thoracoabdominal approach 3 cases(18%). f cases of penetrating diaphragmatic t auma was diagnosed on the operation of other organ injury Now we suggest that diaphragmatic injury should be suspected in all patients with penetrating as well as blunt injury of the chest and abdomen to protect the patient from its late complications.

• Journal of Chest Surgery
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• v.35 no.10
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• pp.730-735
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• 2002

Diaphragm is innervated by phrenic nerve and lower intercostal nerves. For patients with avulsion injury of brachial plexus, an in situ graft of phrenic nerve is frequently used to neurotize a branch of the brachial plexus. We studied short-term and mid-term changes of diaphragmatic level and movement in patients with dissection of phrenic nerve for neurotization. Material and Method : Thirteen patients with division of either-side phrenic nerve for neurotization of musculocutaneous nerve were included in this study. With endoscopic surgical procedure, the intrathoracic phrenic nerve was entirely dissected and divided just above the diaphragm. The dissected phrenic nerve was taken out through thoracic inlet and neck wound and then anastomosed to the musculocutaneous nerve through a subcutaneous tunnel. With chest films and fluoroscopy, levels and movements of diaphragm were measured before and after operation. Result : There was no specific technical difficulty or even minor postoperative complications following endoscopic division of phrenic nerve. After division of phrenic nerve, diaphragm was soon elevated about 1.7 intercostal spaces compared with the preoperative level, but it did not show paradoxical motion in fluoroscopy. More than 1.5 months later, diaphragm returned downward close to the preoperative level (average level difference was 0.9 intercostal spaces; p＝NS). Movement of diaphragm was not significantly decreased compared with the preoperative one. Conclusion : After division of phrenic nerve, the affected diaphragm did not show a significant decrease in movement, and the elevated diaphragm returned downward with time. However, the decreased lung volumes in the last spirometry suggest the decreased inspiratory force following partial paralysis of diaphragm.

• Journal of Trauma and Injury
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• v.23 no.2
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• pp.170-174
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• 2010

Purpose: As techniques and instruments for video-assisted thoracic surgery (VATS) have been evolving, attempts to perform VATS for chest trauma have been increasing. Several studies have demonstrated the feasibility and safety of VATS for thoracic trauma. We reviewed our experience to evaluate the clinical feasibility and safety of VATS for thoracic trauma. Methods: Fifty-two patients underwent thoracic surgery for chest trauma in Asan Medical Center from January 1990 to December 2009. VATS was performed in 21 patients who showed stable vital signs. We reviewed retrospectively the medical records of those patients to investigate the results of VATS for thoracic trauma. Results: Thoracic exploration for chest trauma was performed in 52 patients. There were 46 males (88.5%) and 6 females (11.5%). The median age was 46.0 years (range: 11~81 years). There were 39 blunt and 13 penetrating traumas. A standard posterolateral thoracotomy was performed in 31 patients, and VATS was tried in 21 patients. We performed successful VATS in 13 patients; 11 males (84.5%) and 2 females (15.5%) with a median age of 46.0 years (range: 24~75 years). The indication of VATS was persistent intrathoracic hemorrhage in 10 patients and clotted hemothorax in 3 patients. There were no complications, but there were two mortalities due to multiple organ failure after massive transfusion. In 8 patients, VATS was converted to a standard posterolateral thoracotomy for several reasons. The reason was inadequate visualization for bleeding control or evacuation of the hematoma in 5 patients. In 3 patients, VATS was performed to evaluate diaphragmatic injury. After the diaphragmatic injury had been confirmed, a standard posterolateral thoracotomy was performed to repair the diaphragm. Conclusion: VATS should be safe and efficient method for diagnostic evaluation and surgical management of stable patients with thoracic trauma.