impact of early diagnosis and associated injuries on the outcome of patients with traumatic diaphragmatic rupture

ABSTRACT

Thirty-eight patients with surgically confirmed diagnosis of traumatic diaphragmatic rupture were included in this prospective study. They were classified into two age and sex matched groups Group A included 22 patients where the diaphragmatic rupture was the prime indication for surgical intervention and group B included 16 patients where associated thoraco-abdominal injuries mandated an urgent surgical intervention. In conclusion, a high index of suspicion and awareness of the mechanism of injury are required for the early diagnosis of diaphragmatic rupture. The initial plain chest X-ray is reliable in detecting the diaphragmatic tear, especially in the presence of herniated hollow viscera. Ultrasonography and CT scan are useful auxiliary investigations which improve dramatically the early preoperative diagnosis of diaphragmatic rupture. Due to the severity of trauma required to rupture the diaphragm, associated injuries are common. However, no specific associated injury proved to be a sensitive index for diaphragmatic rupture. During exploratory laparotomy for abdominal trauma, a thorough examination of both hemidiaphragms is mandatory. Postoperative morbidity and mortality could be attributed to the severity of trauma indices and associated injuries but not to the diaphragmatic tear itself