Traumatic rupture of the diaphragm: A 22-patient experience

This study evaluated the demographic and clinical properties, diagnostic and therapeutic approaches, and outcomes of patients with traumatic diaphragmatic injury. Among 853 patients who presented with blunt or penetrating thoracic injury between January 2010 and December 2016, 22 patients with traumatic diaphragmatic rupture were retrospectively studied. The analysed parameters included age, sex, accompanying injuries, surgical management approach, postoperative morbidity and mortality rates, and duration of hospital stay. Among 853 patients treated at our clinic for blunt or penetrating thoracic trauma, 22 patients with diaphragmatic injury (16 males, 6 females) were evaluated. The mean age was 32 (range 19-67 y). Twenty-one patients were evaluated in the acute setting and 1 in the chronic setting (with a history of trauma 8 years earlier). The most common complaints and physical examination findings were dyspnea, chest pain, abdominal distention, and loss of breath sounds over the affected hemithorax. On chest X-Ray the most common signs included loss of dipahragma shadow, diaphragmatic elevation, and visceral organ herniation into thoracic cavity. All patients were operated. As the surgical method, thoracotomy was carried out in 18 patients and laparotomy+thoracotomy was performed in 4 patients. Three patients underwent diagnostic video-assisted thoracoscopy before thoracotomy. Diaphragma was repaired on the left side in 20 patients and on the right side in 2. In 21 patients, a diaphragmatic injury was accompanied by intraabdominal organ injuries, lung injuries, and other system injuries. Stomach was the organ whose injury most commonly accompanied blunt and penetrating injuries. Pulmonary complications were more common in blunt traumas (10%). Death was seen in only one (5%) patient with penetrating trauma. The mean duration of chest drainage tube staying in place was 3 (range 2-8 d); the mean duration of hospital stay was 6 (range 4-10 d).