Management of Patients with Traumatic Rupture of the Diaphragm

Abstract

BackgroundTraumatic rupture of the diaphragm is an unusual type of trauma. In addition, it is difficult to diagnose because it can be accompanied by injuries to other organs. If it is not detected early, the mortality rate can increase due to serious complications. Diaphragmatic rupture is an important indicator of the severity of the trauma. The aim of this study was to investigate the factors affecting the incidence of complications and mortality in patients who had surgery to treat traumatic rupture of the diaphragm.Materials and MethodsThe subjects were patients who had undergone a diaphragmatic rupture by blunt trauma or stab wounds except patients who were transferred to other hospitals within 3 days of hospitalization, from January 2000 to December 2007. This study was a retrospective study. 43 patients were hospitalized, and 40 patients were included during the study period. Among them, 28 were male, 12 were female, and the average age was 42 (from 18 to 80). Outcome predictive factors including hypoxia, ventilator application days, revised trauma score (RTS), injury severity score (ISS), age, herniated organs, complications, and the mortality rate were investigated.ResultsCauses of trauma included motor vehicle crashes for 20 patients (50%), falls for 10 (25%), stab wounds for 8 (20%), and agricultural machinery accidents for 2 (5%). Most of the patients (36 patients; 90%) had wound sites on the left. Diagnosis was performed within 12 hours for most patients. The diaphragmatic rupture was diagnosed preoperatively in 27 patients (70%) and in 12 patients (30%) during other surgeries. For surgical treatment, thoracotomy was performed in 14 patients (35%), laparotomy in 11 (27.5%), and a surgery combining thoracotomy and laparotomy in 15 patients (37.5%). Herniated organs in the thoracic cavity included the stomach for 23 patients (57.5%), the omentum for 15 patients (37.5%), the colon for 10 patients (25%), and the spleen for 6 patients (15%). Accompanying surgeries included splenectomy for 13 patients (32.5%), lung suture for 6 patients (15%), and liver suture for 5 patients (12.5%). The average hospital stay was 47.80±56.72 days, and the period of ventilation was 3.90±5.8 days. The average ISS was 35.90±16.81 (11~75), and the average RTS was 6.46±1.88 (1.02~7.84). The mortality rate was 17.5% (7 patients). Factors affecting complications were stomach hernia and age. Factors affecting the mortality rate were ISS and RTS.ConclusionThere are no typical symptoms of the traumatic rupture of the diaphragm by blunt trauma. Nor are there any special methods of diagnosis; in fact, it is difficult to diagnose because it accompanies injuries to other organs. Stab wounds are also not easy to diagnose, though they are relatively easy to diagnose compared to blunt trauma because the accompanying injuries are more limited. Suture of the diaphragm can be performed through the chest, the abdomen, or the thoracoabdomen. These surgical methods are chosen based on accompanying organ injuries. When there are many organ injuri...

Diaphragmatic rupture: a single-institution experience and review of the literature

“…Magnetic resonance imaging can be a good diagnostic tool, but it cannot be performed in an emergency setting. [21] Oral follow-through study was performed in two patients, and it revealed positive results; chest X-ray results in both these patients were negative. The patients with SDR demonstrated negative results on chest X-ray, chest CT, upper gastrointestinal endoscopy, and abdominal USG before being diagnosed using oral follow-through.…”

“…[18,20] Furthermore, sensitivity of CT in diagnosing acute DR ranges between 33% and 83%, and its specificity ranges between 76% and 100%. [18,21] CT findings in acute DR are hemidiaphragmatic discontinuity, intrathoracic herniation of the abdominal content, and the dependent viscera sign. [22,23] In our series, CT revealed a DR in three of five stable polytraumatized patients.…”

Misdiagnosed Travmatic Diaphragmatic Hernia: Misfortune of the Patient, Guilt of Doctor?

“…Diyafragma hernilerinin tedavisi cerrahidir. Cerrahide torakotomi, laparotomi veya her iki yaklaşımın aynı ayda uygulanması gerektiğini savunan çalışmalar mevcuttur [6,7]. Bununla beraber torakoabdominal yaklaşımın en ideal cerrahi yaklaşım olduğu görüşünde olanlar da vardır [8].…”

Anaesthesia Management of a Patient with Incidentally Diagnosed Diaphragmatic Hernia During Laparoscopic Surgery

“…Anahtar Kelimeler: Travmatik diyafragma hernisi, anestezi, genel, oksijen, azot protoksit Özet / Abstract Giriş D iyafragma, en önemli solunum kasıdır (1). Diyafragma üzerinde bir defekt sonucu ortaya çıkan diyafragma hernileri, kalıtsal veya kazanılmış olabilirler.…”