Blunt injuries of the diaphragm

ABSTRACT

Over a 9-year period, 15 patients [12 males and 3 females] with blunt traumatic rupture of the diaphragm were managed in Banha University Hospital. Their age ranged from 18-49 years. Automobile accident was the main traumatic mechanism in 12 patients. 3 patients presented with diaphragmatic hernia due to missed detection of diaphragmatic rupture a month to 2 years following the accident. The other 12 patients presented with acute diaphragmatic ruptures which could be diagnosed on emergency laparotomy [4 patients], within 24 hours [6 patients] and after 48-72 hours [2 patients]. Left and right diaphragmatic ruptures were encountered in 12 and 3 patients respectively. Transabdominal repair was the procedure of choice in the acutely injured patients due to the presence of associated abdominal injuries in all of them, with extension to right and left thoracotomy in 4 patients. Thoracic approach was used in the repair of missed cases. Diaphragmatic tears were repaired by interrupted mattress silk sutures [12 cases], or double breasting [3 cases] when enough tissues were available. Mortality rate was 20% which was not related to diaphragmatic injuries but reflecting the severity of associated traumatic injuries. Awareness of the possibility of traumatic diaphragmatic ruptures with major blunt trauma to abdominothoracic region and the presense of strongly suspicious clinical and radiological evidence of diaphragmatic rupture remain the best way of making early diagnosis and hence successful management of the condition