Traumatic Diaphragmatic Rupture – A Clinical Experience Over Two Decades

Abstract

Introduction: Traumatic diaphragmatic rupture was once only reported in post mortem findings. But due to better advanced trauma and life support services and increased survival of the trauma patients, these are now diagnosed with increasing frequency. The purpose of this study was to present our experience with its different mechanisms of rupture and its management. The aim of this retrospective study was to evaluate manifestations of effects of diaphragmatic rupture after thoraco-abdominal trauma, and to discuss their epidemiology, diagnosis, nature and treatment with an aim to impart comprehensive timely management to reduce morbidity and mortality. Material and methods: It is the report of combined experience of the authors on 18 patients with traumatic diaphragmatic rupture with (TDR) or without traumatic diaphragmatic hernia (TDH) treated in two Medical College Hospitals in Kolkata, from 1998 to 2019, and a retrospective analysis was performed. 9 patients who presented with severe injury with features of internal injury were operated early and 9 with non severe injury were operated later. Results: Out of 18 patients, 14 had history of blunt trauma and 4 had history of penetrating trauma. 4 patients with penetrating together with 5 with blunt injury were included in the severe group and had undergone early surgery due to suspected internal injuries. Out of these 9 patients, 5 patients having TDR and 1 having TDH died due hemorrhage and / or sepsis with a mortality of 33.33. TDH was diagnosed by imaging studies in 9 patients in non severe group while 1 was diagnosed intra operatively in the severe group. Conclusions: Though priority of a blunt or a penetrating trauma patient involves resuscitation and early surgery when indicated, careful understanding of mechanism of injury can guide the emergency surgeon to suspect and examine the diaphragm for any TDR to prevent further complication. In addition to X rays computer tomographic study when available becomes helpful in preoperative planning of surgery for closure of TDR or TDH.