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Blunt traumatic diaphragmatic rupture: a retrospective observational study of 46 patients

^a Department of Cardiothoracic Surgery, Mansoura University Hospitals, Faculty of Medicine, Mansoura University, Gomhoria St., Mansoura, P.O. Box 35516, Egypt
^b Department of General Surgery, Mansoura University Hospitals, Faculty of Medicine, Mansoura University, Gomhoria St., Mansoura, P.O. Box 35516, Egypt
^c Department of Anesthesia, Mansoura University Hospitals, Faculty of Medicine, Mansoura University, Gomhoria St., Mansoura, P.O. Box 35516, Egypt

*Corresponding author. Department of Cardiac Surgery, Prince Sultan Cardiac Center, P.O. Box 99911, Riyadh 11625, KSA, Bleep no: 4320. Tel.: +96612068132; mobile: +966558267049.

E-mail address: redahammad2000{at}gmail.com; reda_hammad2000{at}yahoo.com (R.E. Al-Refaie).

A retrospective study aimed to analyze our experience in 46 patients with blunt traumatic diaphragmatic rupture (BTDR) admitted to our tertiary hospital from 1995 to 2007. Charts, chest roentgenograms (CXR), and computed tomography (CT) scans were carefully reviewed. The mean age was 36.5±10.1 years, 36 (78.3%) were males. The etiology was a traffic accident in 36 (78.3%) patients. BTDR was left-sided in 34 (73.9%) and right-sided in 12 (26.1%) patients. CXR was diagnostic in 26 (56.5%) and CT in 12 (26.1%) patients. Associated injuries included lung 12 (26.1%), liver 10 (21.7%), spleen 24 (52.2%) and bowel 2 (4.2%) patients. BTDR was approached through thoracotomy 26 (56.5%), laparotomy 16 (34.8%), and combined approach 4 (8.7%) patients. The repair was primarily with interrupted non-absorbable sutures in 42 (91.3%) and by prosthetic mesh in four patients. Complications developed in 20 patients. Mortality was observed in 2 (4.3%) patients. We concluded that BTDR is a common lesion in young adult males on the left side caused by a traffic accident. A high index of suspicion combined with repeated and selective radiologic evaluation is necessary for early diagnosis. Associated injuries represent the main prognostic factor affecting morbidity and mortality. Thoracotomy and primary repair is adequate surgical treatment.

Key Words: Blunt trauma; Diaphragmatic rupture; Associated injuries; Acute presentation; Thoracotomy; Laparotomy

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