Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents following high-energy blunt or penetrating thoracoabdominal trauma. Chief complaints include acute respiratory distress, pleuritic chest pain, and referred shoulder pain (Kehr's sign). History notable for mechanism of injury consistent with sudden increase in intra-abdominal pressure.
Clinical Examination Findings
Physical exam reveals diminished breath sounds on the affected side, potential bowel sounds auscultated in the thoracic cavity, and scaphoid abdomen. Hemodynamic status ranges from stable to signs of obstructive shock. Chest wall integrity and abdominal tenderness assessed.
Treatment Protocol
Immediate surgical intervention indicated. Approach via laparotomy (acute) or thoracotomy (chronic/right-sided). Reduction of herniated viscera into the peritoneal cavity, debridement of devitalized tissue, and primary repair of the diaphragmatic defect using non-absorbable interrupted sutures. Mesh reinforcement considered for large defects.