Entrapment of the colon following diaphragmatic injuries: report of eight cases.
With a rise in the incidence of severe injuries, we are seeing increasing numbers of patients with colonic entrapment occurring at the sites of diaphragmatic injuries. The initial injury might have occurred recently or it might have occurred as long as 25 years before. Blunt trauma, stabbings, and infection accounted for the initial trauma in our patients. Acute symptoms implicate the cardiorespiratory system as a result of interference with respiration and the filling and function of the heart. Acute or chronic gastrointestinal symptoms may suggest intestinal obstruction or functional bowel disorders. The proper diagnosis of colonic entrapment depends upon a high index of suspicion and proper studies. Chest x-rays, fluoroscopy, barium-enema examinations and contrast studies of the upper gastrointestinal tract are essential. Acute cardiorespiratory enbarrassment necessitates prompt surgical intervention. When subdiaphragmatic injuries are suspected, an abdominal incision is necessary. In long-standing cases where the abdominal viscera are intact, the thoracic approach is preferable. At times, the combined thoraco-abdominal incision may be preferable. Diaphragmatic injuries resulting in colonic entrapment occurred most often in the left hemidiaphragm, which is relatively unprotected. In seven of our eight patients, the left diaphragm was the site of herniation. The liver on the right side serves to protect this area from herniation. Only the largest defects permit displacement of the liver into the right chest. Only one of our patients had such a defect. Patients with long-standing cardiac or gastrointestinal symptoms suggestive of colonic entrapment should have a THOROUGH MEDICAL evaluation before any operative treatment is advised. We have reviewed the cases of eight patients in whom infection, stabbings and blunt trauma resulted in diaphragmatic herniations with subsequent colonic entrapment. The splenic flexure of the colon protruded through the defect in three of our eight patients. The transverse colon was located above the diaphragm in five.