A 26-year-oldman, Raju met with an accident & is brought to emergency. The person accompanying him informed that a truck run over the patient. CXR reveals an air fluid level in left lung &nasogastric tube got coiled upward into left chest. Which of the following is the next best step in management of this patient?
This is likely a case of acute diaphragmatic rupture and should be treated with immediate laparotomy. Etiology of diaphragmatic rupture: 1. Penetrating trauma 2. Blunt trauma - Comprehensive force applied to pelvis or abdomen Clinical features: Most injuries are Silent Patients presents with S/S of injury of associated organs Late complication of diaphragmatic injury -Herniation Most common organ herniated - Stomach > colon > Small intestine Investigations VATS (Video assisted Thoracoscopy) Laparoscopy & evaluate the other abdominal organs Treatment: Operative repair in all cases BergquistTraid: Rib fracture Spine or Pelvic fracture Traumatic rupture of diaphragm
Placement of a chest tube on left side
Thoracotomy
Diagnostic peritoneal lavage
Laparotomy
Trauma