Surgical management of traumatic diaphragmatic rupture: ten-year experience in a Teaching Hospital in Ghana

Abstract

Introduction Diaphragmatic injuries may be associated with thoracoabdominal blunt or penetrating traumas. The diagnosis is often delayed, despite the availability of several medical imaging modalities. The surgical management remains controversial, in terms of the choice of surgical approach and the surgical repair technique. Aim To evaluate the surgical management experience of traumatic diaphragmatic rupture in our institution over a ten-year period in the local setting of a tertiary hospital in Ghana. Material and methods A retrospective review of the medical records of patients who had undergone surgery for traumatic diaphragmatic rupture. Results A total of 35 cases of diaphragmatic rupture were seen from thoracoabdominal injuries. There were 29 (82.86%) males. The mean age was 36.25 ±12.98 years with a range of 16–65 years. There were 3 cases of right diaphragmatic rupture and 32 cases of left diaphragmatic rupture. Penetrating chest injury caused 18 (51%) of the ruptures. The leading cause of injury was road traffic accident, which constituted 48.57%, closely followed by stab (25.71%), gunshot injuries (14.29%) and impalement injury (11.48%). Seventeen (49%) patients had their diaphragmatic ruptures repaired via laparotomy and the remaining 18 (51%) via thoracotomy. The commonest herniated organ was the stomach. One patient died in theatre from cardiac arrest after failed intubation. Conclusions Surgery is the treatment of choice in traumatic diaphragmatic rupture and it is repaired via laparotomy or thoracotomy based on the presence or absence of concomitant abdominal injury and the presence or absence of a cardiothoracic surgeon.

Laparoscopic management of traumatic diaphragmatic rupture with herniation of abdominal contents into left hemithorax

“…It is more common among middle‐aged males, left‐sided in approximately half of the patients, and associated with rib fractures in 60.7% of patients 2 . The stomach, colon, omentum, and small bowel often herniate into the thoracic cavity 4,5 . Though chest X‐ray (CXR) is the first line of imaging modality, the sensitivity is low 1 .…”

“…2 The stomach, colon, omentum, and small bowel often herniate into the thoracic cavity. 4,5 Though chest X-ray (CXR) is the first line of imaging modality, the sensitivity is low. 1 Hence, the mainstay of diagnosis is computed tomography (CT) scan imaging.…”