Diaphragmatic Injuries: A Surgical Challenge. Report of Forty-one Cases

Abstract

Background: We present a discussion of the management of diaphragmatic injury and the factors that influence the choice of surgical approach based on our experience and a review of the literature. Methods: Data of 41 patients with diaphragmatic injuries treated between 1996 and 2007 were analyzed retrospectively. Results: A total of 29 men and 12 women between 15 and 56 years of age (mean age 34) were included in the study. Twenty-one patients had penetrating injuries and 20 patients had blunt injuries. The diagnosis was done preoperatively in 21 cases and intraoperatively in 20 cases. Thoracotomy was used in 23 cases, laparotomy in 11 cases, laparotomy-thoracotomy in 5 cases, sternotomy-laparotomy in 1 case, and sternotomy in 1 case. Emergency surgery was performed in 30 cases. Five cases were operated within 24 hours after admission to the emergency department. In 6 cases, surgery was performed 6 months to 4 years after the initial trauma. The mortality rate was 14.6 % and the operative morbidity was 2.4 %. Conclusion: A high index of suspect is vital for the diagnosis of diaphragmatic injuries in an emergency setting. The type of approach is closely related to the associated injuries.

thoracic surgery - diaphragmatic injury - urgent surgery

References

• 1 Rubikas R. Diaphragmatic injuries.  Eur J Cardiothorac Surg. 2001;  20 (1) 53-57
• 2 Cubukcu A, Paksoy M, Gönüllü N N, Sirin F, Dülger M. Traumatic rupture of the diaphragm.  Int J Clin Pract. 2000;  54 19-21
• 3 Tiberio G A, Portolani N, Coniglio A, Baiocchi G L, Vettoretto N, Giulini S M. Traumatic lesions of the diaphragm. Our experience in 33 cases and review of the literature.  Acta Chir Belg. 2005;  105 82-88
• 4 Haciibrahimoglu G, Solak O, Olcmen A, Bedirhan M A, Solmazer N, Gurses A. Management of traumatic diaphragmatic rupture.  Surg Today. 2004;  34 111-114
• 5 Mihos P, Potaris K, Gakidis J et al. Traumatic rupture of the diaphragm: experience with 65 patients.  Injury. 2003;  34 169-172
• 6 Hanna W C, Ferri L E, Fata P, Razek T, Mulder D S. The current status of traumatic diaphragmatic injury: lessons learned from 105 patients over 13 years.  Ann Thorac Surg. 2008;  85 1044-1048
• 7 Shah R, Sabanathan S, Mearns A J, Choudry A K. Traumatic rupture of the diaphragm.  Ann Thorac Surg. 1995;  60 1444-1449
• 8 Sliker C W. Imaging of diaphragm injuries.  Radiol Clin North Am. 2006;  44 199-211
• 9 Patselas T N, Gallagher E G. The diagnostic dilemma of diaphragm injury.  Am Surg. 2002;  68 633-639
• 10 Eren S, Kantarci M, Okur A. Imaging of diaphragmatic rupture after trauma.  Clin Radiol. 2006;  61 467-477
• 11 Blaivas M, Brannam L, Hawkins M, Lyon M, Sriram K. Bedside emergency ultrasonographic diagnosis of diaphragmatic rupture in blunt abdominal trauma.  Am J Emerg Med. 2004;  22 601-604
• 12 Matsevych O Y. Blunt diaphragmatic rupture: four year's experience.  Hernia. 2008;  12 73-78
• 13 Arak T, Solheim K, Pillgram-Larsen J. Diaphragmatic injuries.  Injury. 1997;  28 113-117
• 14 Esme H, Solak O, Sahin D A, Sezer M. Blunt and penetrating traumatic ruptures of the diaphragm.  Thorac Cardiovasc Surg. 2006;  54 324-327
• 15 Küçük H F, Demirhan R, Kurt N, Ozyurt Y, Topaloğlu I, Gülmen M. Traumatic diaphragmatic rupture: analysis of 48 cases.  Ulus Travma Derg. 2002;  8 94-97
• 16 Ozgüç H, Akköse S, Sen G, Bulut M, Kaya E. Factors affecting mortality and morbidity after traumatic diaphragmatic injury.  Surg Today. 2007;  37 1042-1046
• 17 Duzgun A P, Ozmen M M, Saylam B, Coskun F. Factors influencing mortality in traumatic ruptures of diaphragm.  Ulus Travma Derg. 2008;  14 132-138