Surgical management of traumatic diaphragmatic hernia: a single institutional experience of more than two decades

Abstract

Background We present here our experience with surgical management of traumatic diaphragmatic hernia, trying to find out the era impact of different periods on the outcome and risk factors of mortality. Methods A series of 63 patients with traumatic diaphragmatic hernia were referred to us and operated on during March, 1990-August, 2017. The patient records were reviewed and statistically analyzed to demonstrate injury characteristics and to find out optimal treatment strategy, risk factors of death as well as the difference between two periods (1990–2005, 2005–2017) divided by introduction of computed tomography at our institution. Results The overall mean age was 31.2 ± 16.3 years old with a female to male ratio of 11/52. The mechanism was penetrating trauma in 19 cases (30.2%), and blunt trauma in 44 cases (69.9%). Two thirds of the patients in the second group (2005–2017) yet none in the first group (1990–2005) underwent computed tomography. Ten patients (15.9%), of which 8 in the first and the other 2 in the second group (p = .042), had late diagnoses. The most commonly used incision was a thoracotomy (n = 43, 89.6%). There was no statistical difference in etiology or mortality between the two periods. Univariate analysis showed survivors were younger, and had lesser injury severity scores (ISS) and lower American Association for the Surgery of Trauma (AAST) grade than non-survivors. By multivariate logistic regression analysis, increased age (odds ratio, 1.275; p = .013) and greater ISS (OR, 1.174; p = .028) were risk factors of death in all patients. Conclusions High-definition computed tomography has significantly improved the preoperative diagnosis rate. The transthoracic approach could be used in selected cases with traumatic diaphragmatic hernia with good outcomes. Patients with greater ISS and advanced ages are at a higher risk of death.

Colonic perforation in a right atraumatic diaphragmatic hernia

“…In an acute traumatic event resulting in intra-abdominal organs herniating intra-thoracically, a laparotomy is acceptable, especially where associated abdominal injuries may exist, but a thoracotomy or even a combined set of incisions has been described to good effect in older injuries. 7,8 The debate as to whether to perform a primary anastomosis or an ileostomy, with mucous fistula omnipresent, with the factors of intraoperative contamination, infection, the use of blood products and vasopressors favouring diversion. 9,10 It should be noted, however, that the surgical decision-making must take into consideration the morbidity and mortality associated with stoma reversal as well as the social, physical and sexual side effects of an ileostomy fashioned without precounselling.…”

Rare association of traumatic diaphragmatic hernia with spinal cord injury: A case report

“…These injuries will increase the mortality and morbidity of the patient and delay the surgical intervention for the spine [2] . Diaphragmatic injuries have commonly occurred with blunt forces (3.4%) [7] , [8] . 75–80% cases blunt trauma causes injury to the left hemi-diaphragm [7] .…”

“…Intra-abdominal access, Posterolateral thoracotomy, and combined thoracoabdominal incisions are used to repair the Diaphragmatic hernia [8] . Laparotomy incision was used in this case because of the suspicion of other intraabdominal injuries, early surgery, and familiarity with the surgeon.…”

“…Laparotomy incision was used in this case because of the suspicion of other intraabdominal injuries, early surgery, and familiarity with the surgeon. Posterolateral thoracotomy warrants a good exposure for isolated diaphragmatic hernia and it will help to release the intrathoracic adhesions in delayed surgeries [8] .…”

Post-traumatic diaphragmatic hernia

“…Nabyte przepukliny przeponowe mogą wystąpić zarówno po urazach tępych (69,8%), jak i przenikających (30,2%) [1]. Wspólnym i charakterystycznym elementem w obu przypadkach jest wysoka siła urazu.…”