Review of 9 Cases of Diaphragmatic Injury Following Blunt Trauma Chest; 3 Years Experience

Abstract

Diaphragmatic injuries can occur with both blunt and penetrating trauma which can be associated with herniation of abdominal viscera into the thoracic cavity. Diaphragmatic injuries can occur with blunt trauma chest in 1-7 % of patients. Retrospectively for last 3 years all cases blunt trauma chest admitted to surgery were reviewed and a study of cases of diaphragmatic rupture was done. We analysed 496 patients of blunt trauma chest retrospectively for period of three years. Nine patients have diaphragmatic injuries, all were males, six presented acutely three were chronic. In six patients laparotomy was done, four subcostal and two midline incisions were preferred. In chronic cases thoracotomy was done. Left sided injury predominates and rib fractures are most common associated finding. Diagnosis in majority of cases is made by Computerised tomography scan. Subcostal incision may be used in patients with isolated diaphragmatic injury in acute presentation while thoracotomy is preferred in late cases. Most common morbidity is pulmonary complications.

Traumatic right diaphragmatic rupture with hepatothorax in Ghana: two rare cases

“…Moreover there some absolute indications for a thoracotomy approach in diaphragmatic ruptures and this include diaphragmatic injuries involving the thoracic aorta, thoracoabdominal impalement injury, pericardiodiaphragmatic ruptures and severe contamination of the thoracic cavity. Repair of delayed diaphragmatic ruptures are also approached through thoracotomy [6]. Although this approach provides excellent exposure to divide the adhesions between the trapped viscera and lung parenchyma, a transabdominal approach may be preferable for a delayed left hemidiaphragm rupture in which segments of small or large bowel may have to be resected and anastomosed.…”

Sudden death caused by diaphragmatic rupture following rib fracture in a female sika deer (Cervus nippon) at a zoo

“…These injuries are induced by an increase in abdominal pressure that may cause diaphragmatic tear and visceral herniation [10]. In humans, herniation into the thoracic cavity is often observed, and the delayed presentation of symptoms can lead to complications and increased mortality [4,14].…”

“…The decrease in thoracic volume causes an increase in abdominal pressure, which affects the respiratory system and causes compression of the vena cava and reduced venous return to the heart. These result in respiratory failure and cardiovascular collapse [1,6,10].…”

“…In humans, the incidence of diaphragmatic injuries ranges from 1% to 7% in cases of blunt trauma and from 10% to 15% in cases of penetrating wounds [10]. Moreover, injuries are more frequent on the left side (66%) than on the right side (32%) because of the higher frequency of right-handedness among humans [10].…”

“…Moreover, injuries are more frequent on the left side (66%) than on the right side (32%) because of the higher frequency of right-handedness among humans [10]. Rupture of the diaphragm often occurs in men and in young people who participate in various physical activities [6].…”