Laparoscopy in trauma

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Stephen

I suspect it has to do with the part of the diaphragm injured. Most of the
hernias present in those with holes in the fibrous central tendon - the
bit that rises high up during expiration - thus being prone to injury
during a chest stab - one is inclined to shout "ouch" = expiration.

As to why some herniate then - the injuries to the musclular portion I
would postulate heal themselves, while tendonous injuires do not -
negative pressure in the chest can slowly drag bowel into the gap. Most, I
suspect, get blocked by that good policeofficer of the abdomen - omentum
and are not heard about again.

Regards
Tim

Dr T C Hardcastle
M.B., Ch.B. (Stell); M. Med. (Chir) (Stell); FCS (SA)
Principal Specialist Trauma Surgeon /
Honorary Lecturer UKZN Dept Surgery
Deputy Director - IALCH Trauma Service
> On Sun, Nov 23, 2008 at 8:07 PM, McSwain, Norman E Jr.
> <nmcswai at tulane.edu>wrote:
>
>> Tim
>>
>> Sorry for the late response but I was on in-house trauma call yesterday
>> and
>> had to nap this afternoon. Yes, I know I am a wimp
>>
>> As you know, Scott Frame (when he was a fellow with me) did some small
>> animal research that demonstrated the almost 100% of the mice with a
>> hole in
>> the diaphragm that was the side of the diameter of the small bowel would
>> develop a hernia. My personal experience (I know, poor data) we do not
>> see
>> as many hernias in humans.
>
> I am not sure why
>
>
> Perhaps it has something to do with the fact that we are bipedal creatures
> and the position most of us are in most of the time allows for gravity to
> aid in keeping our bowels in the proper compartment.  This is just a stab
> in
> the dark and I could be wrong, but that would be my guess.
>
>
>
> --
> Stephen L. Richey, CRT
> Aviation Injury Research Project Leader
> Saginaw Valley State University
> Work E-mail: slrichey at svsu.edu
> Home Office Phone: 248-366-4452
>
> "Hier stehe ich. Ich kann nicht anders. Gott helfe mir. Amen."- Martin
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