Traumatic Diaphragmatic Rupture – A Clinical Experience Over Two Decades

ABSTRACT

Introduction: Traumatic diaphragmatic rupture was onceonly reported in post mortem findings. But due to betteradvanced trauma and life support services and increasedsurvival of the trauma patients, these are now diagnosed withincreasing frequency. The purpose of this study was to presentour experience with its different mechanisms of ruptureand its management. The aim of this retrospective studywas to evaluate manifestations of effects of diaphragmaticrupture after thoraco-abdominal trauma, and to discusstheir epidemiology, diagnosis, nature and treatment with anaim to impart comprehensive timely management to reducemorbidity and mortality.Material and methods: It is the report of combined experienceof the authors on 18 patients with traumatic diaphragmaticrupture with (TDR) or without traumatic diaphragmatichernia (TDH) treated in two Medical College Hospitals inKolkata, from 1998 to 2019, and a retrospective analysis wasperformed. 9 patients who presented with severe injury withfeatures of internal injury were operated early and 9 with nonsevere injury were operated later.Results: Out of 18 patients, 14 had history of blunt traumaand 4 had history of penetrating trauma. 4 patients withpenetrating together with 5 with blunt injury were includedin the severe group and had undergone early surgery due tosuspected internal injuries. Out of these 9 patients, 5 patientshaving TDR and 1 having TDH died due hemorrhage and /or sepsis with a mortality of 33.33. TDH was diagnosed byimaging studies in 9 patients in non severe group while 1 wasdiagnosed intra operatively in the severe group.Conclusions: Though priority of a blunt or a penetratingtrauma patient involves resuscitation and early surgery whenindicated, careful understanding of mechanism of injury canguide the emergency surgeon to suspect and examine thediaphragm for any TDR to prevent further complication.In addition to X rays computer tomographic study whenavailable becomes helpful in preoperative planning of surgeryfor closure of TDR or TDH.