Diaphragmatic injury in Benghazi

ABSTRACT

Diaphragmatic injuries [DI] are frequently overlooked and remain a challenge to the treating surgeon. The purpose of our study was to analyze the incidence, mechanism of injury, the diagnosis and the treatment as well as the outcome of DIs and to discuss the difficulties in their diagnosis. A retrospective chart review of all patients operated on for blunt and penetrating injuries of chest and abdomen at Al-Jala hospital in Benghazi in the period from jan.2004 to Dec. 2006. 253 operated patients for thoracoabdominal trauma, blunt 150[59.3%] and penetrating 103[40.7%], of which 28 patients [11%] with DI were included in this study. Demographic data, diagnosis, treatment and outcome were analyzed. Twenty patients [71.4%] had civilian penetrating diaphragmatic injuries [PDI] and eight [28.6%] had blunt diaphragmatic trauma [BDT]. Two cases of BDT had a delayed diagnosis [>24 hours] after repeated chest roentgen and only one of PDI had a delayed diagnosis [3 years after stab injury]. Mortality rate in PDI was 15% [3 patients], 2 after gunshot and only one after stab due to other associated injuries. For BDT mortality rate was 37.5% [3 patients] which is more than that of PDI. The preoperative diagnosis of DI is difficult and in our group the diagnosis was made in almost all the cases during the emergency laparotomy or thoracotomy or both for penetrating wound, shock or peritoneal or chest signs. The diagnosis of BDT is more difficult and can be suspected by abnormal chest x-ray. The role of laparoscopy or thoracoscopy in detecting DI should be considered in future in our hospital. A high rate of suspicion is needed to detect DI and to avoid the fatal complications i.e. strangulation of viscera