Thorac Cardiovasc Surg 2006; 54(5): 324-327
DOI: 10.1055/s-2006-923892
Original Thoracic

© Georg Thieme Verlag KG Stuttgart · New York

Blunt and Penetrating Traumatic Ruptures of the Diaphragm

H. Esme1 , O. Solak1 , D. A. Sahin2 , M. Sezer3
  • 1Department of Thoracic Surgery, Afyon Kocatepe University, Faculty of Medicine, Afyon, Turkey
  • 2Department of General Surgery, Afyon Kocatepe University, Faculty of Medicine, Afyon, Turkey
  • 3Department of Pulmonary Diseases, Afyon Kocatepe University, Faculty of Medicine, Afyon, Turkey
Further Information

Publication History

Received October 20, 2005

Publication Date:
10 August 2006 (online)

Abstract

Background: The difficulties in diagnosing traumatic diaphragmatic rupture (TDR) at the first admission are the most common causes of morbidity and mortality. The purpose of this study was to review our experience with the management of TDR in order to identify the factors contributing to diagnostic delay and associated morbidity and mortality. Methods: Fourteen patients with TDR were treated in our hospital between January 2000 and June 2005. They have been investigated retrospectively. Results: The study identified 9 men (64 %) and 5 women (36 %), with ages ranging from 19 to 65 years (mean 35.3 years). Rupture of the diaphragm was left-sided in 10 (71 %) and right-sided in 4 (29 %) of the patients. Blunt trauma accounted for the injuries of 11 patients (79 %). Early diagnosis was obtained in 9 patients (64 %). The diagnosis was established preoperatively in 8 patients (57 %), and intraoperatively in 4 (29 %). The diagnosis was missed in 2 (14 %) patients in the first operation. Multiple associated injuries were observed in 12 patients (85 %). Postoperative complications were encountered in five patients (35 %), and the overall mortality was 7 %. Conclusions: Diaphragmatic rupture should be suspected in all blunt or penetrating traumas of the thorax and abdomen, and the presence of such an injury should be excluded before terminating the exploratory procedure.

References

  • 1 Meyers B F, McCabe C J. Traumatic diaphragmatic hernia: occult marker of serious injury.  Ann Surg. 1993;  218 783-790
  • 2 Gallan G, Penalver J C, Paris F. et al . Blunt chest injuries in 1696 patients.  Eur J Cardiothorac Surg. 1992;  6 284-287
  • 3 Haciibrahimoglu G, Solak O, Olcmen A. et al . Management of traumatic diaphragmatic rupture.  Surg Today. 2004;  34 111-114
  • 4 Reber P U, Schmied B, Seiler C A. et al . Missed diaphragmatic injuries and their long-term sequelae.  J Trauma. 1998;  44 183-188
  • 5 Murray J G, Caoili E, Gruden J F. et al . Acute rupture of the diaphragm due to blunt trauma: diagnostic sensitivity and specificity of CT.  AJR. 1996;  166 1035-1039
  • 6 Guth A A, Pachter H L, Kim U. Pitfalls in the diagnosis of blunt diaphragmatic injury.  Am J Surg. 1995;  170 5-9
  • 7 Shah R, Sabanathan S, Mearns A. et al . Traumatic rupture of diaphragm.  Ann Thorac Surg. 1995;  60 1444-1449
  • 8 Shapiro M, Heiberg E, Durham R. et al . The unreliability of CT scans and initial chest radiographs in evaluating blunt trauma induced diaphragmatic rupture.  Clin Radiol. 1996;  51 27-30
  • 9 Sharma O P. Pericardio-diaphragmatic rupture: five new cases and literature review.  J Emerg Med. 1999;  17 963-968
  • 10 Athanassiadi K, Kalavrouziotis G, Athanassiou M. et al . Blunt diaphragmatic rupture.  Eur J Cardiothorac Surg. 1999;  15 469-474
  • 11 Kearney P, Rouhana S, Burney R. Blunt rupture of the diaphragm: mechanism, diagnosis, and treatment.  Ann Emerg Med. 1989;  18 1326-1330
  • 12 McElwee T B, Myers R T, Penell T C. Diaphragmatic rupture from blunt trauma.  Am Surg. 1984;  50 143-149
  • 13 Sharma O P. Traumatic diaphragmatic rupture: not an uncommon entity - personal experience with collective review of the 1980’s.  J Trauma. 1989;  29 678-682
  • 14 Killeen K, Mirvis S, Shanmuganathan K. Helical CT of diaphragmatic rupture caused by blunt trauma.  Am J Roentgenol. 1999;  173 1611-1616
  • 15 Adler D H. Blunt diaphragmatic injury in a 7-year-old girl.  J Emerg Med. 2002;  23 39-42
  • 16 Spann J C, Nwariaku F E, Wait M. Evaluation of video-assisted thoracoscopic surgery in the diagnosis of diaphragmatic injuries.  Am J Surg. 1995;  170 628-631

MD Hidir Esme

Afyon Kocatepe University, Faculty of Medicine
Department of Thoracic Surgery

Pembe Hastane

03200 Afyon

Turkey

Phone: + 905336471729

Fax: + 90 27 22 17 20 29

Email: hesme@aku.edu.tr