Blunt traumatic diaphragmatic rupture: a retrospective observational study of 46 patients

Abstract

A retrospective study aimed to analyze our experience in 46 patients with blunt traumatic diaphragmatic rupture (BTDR) admitted to our tertiary hospital from 1995 to 2007. Charts, chest roentgenograms (CXR), and computed tomography (CT) scans were carefully reviewed. The mean age was 36.5+/-10.1 years, 36 (78.3%) were males. The etiology was a traffic accident in 36 (78.3%) patients. BTDR was left-sided in 34 (73.9%) and right-sided in 12 (26.1%) patients. CXR was diagnostic in 26 (56.5%) and CT in 12 (26.1%) patients. Associated injuries included lung 12 (26.1%), liver 10 (21.7%), spleen 24 (52.2%) and bowel 2 (4.2%) patients. BTDR was approached through thoracotomy 26 (56.5%), laparotomy 16 (34.8%), and combined approach 4 (8.7%) patients. The repair was primarily with interrupted non-absorbable sutures in 42 (91.3%) and by prosthetic mesh in four patients. Complications developed in 20 patients. Mortality was observed in 2 (4.3%) patients. We concluded that BTDR is a common lesion in young adult males on the left side caused by a traffic accident. A high index of suspicion combined with repeated and selective radiologic evaluation is necessary for early diagnosis. Associated injuries represent the main prognostic factor affecting morbidity and mortality. Thoracotomy and primary repair is adequate surgical treatment.

Patterns and Short Term Outcomes of Chest Injuries at Mbarara Regional Referral Hospital in Uganda

“…The diagnosis of blunt trauma diaphragmatic rupture begins with clinical suspicion. 23 Tariq et al 24 also found that about 50% of the diaphragmatic injuries were diagnosed for the first time at laparotomy or thoracotomy for other concomitant injuries.…”

Delayed Presentation of Traumatic Diaphragmatic Hernia: A Case Report

“…Early deaths usually are a result of associated injuries not the diaphragmatic tear. Other main causes included preoperative hemorrhagic shock, and the development of adult respiratory distress syndrome (ARDS) 6 . Postoperative complication developed in 43.5% patients mainly related to pulmonary complications.…”

Rupture diaphragmatique bilatérale post-traumatique isolée: une observation exceptionnelle

“…La symptomatologie clinique, peu spécifique, est souvent masquée par d'autres lésions mettant le pronostic en jeu [7]. La radiographie pulmonaire, réalisée systématiquement en cas de polytraumatisme, peut affirmer le diagnostic en montrant des éléments digestifs ou le trajet de la sonde nasogastrique dans le thorax, mais sa sensibilité est faible.…”