Early diagnosis of traumatic diaphragmatocele associated with pelvic fracture / 中华骨科杂志

ABSTRACT

Objective To clarify the features and early diagnosis of the traumatic diaphragmatocele associated with pelvic fracture. Methods The clinical materials of 486 multiple injuried patients with pelvic fractures as main trauma were retrospectively analysed. The pathogenesis, clinical manifestation and reasons for misdiagnosis in 9 cases of traumatic diaphragmatocele were analysed. Results In this series, the incidence of the traumatic diaphragmatocele was 1.9%(9 of 486). Because of under recognition of this associated injury, 7 in 9 cases of traumatic diaphagmatocele were misdiagnosed or undiagnosed. The incidence of misdiagnosis was 77.8% in this series. Conclusion The main reason for the occurrence of diaphragmatocele was the rapid increase of the intra abdominal pressure which resulted in rupture of the weak area of the diaphragm. Type B1 pelvic fracture can cause traumatic diaphragmatocele easily. The symptoms of the diaphragm hernia are easily overlooked when the trauma is serious or the patient is in shock. Because the early symptoms are not often evident and typical, the doctor can not notice it thoroughly. The main reason for misdiagnosis of the diaphragm hernia is the poor clinical presentation and sign of the diaphragmtocele which initially is very similar to that of the thoraco abdominal injury. In the case with chest and abdominal symptoms concomitant with pelvic fracture should be observed carefully and the chest and abdominal radiographs should be taken as soon as possible. Closed attention should be paid to diaphragmatocele when treating a pelvic fracture in consideration of 7 out of 9 patients being misdiagnosed in this series.