The aim of this work is to describe the diagnostic and therapeutic work-up for the management of 13 blunt trauma cases with acute traumatic diaphragmatic rupture [TDR] in a single institution.
This study was conducted at King Saud Hospital [350 beds], Al-Qassim Region, Saudia Arabia. All patients were resuscitated and underwent emergency chest x-ray examination, abdominal ultrasonography [US] and thoraco-abdominal CT. After hemodynamic stabilization, patients underwent exploratory lap-arotomy; through a midline incision to deal with injuries including repair of the diaphragmatic rupture. The study included 13 patients; 11 males and 2 females with a mean age of 38.6 +/- 7.6 years. Admission chest x-ray defined 5 cases with TDR; 4 left and one right rapture with a sensitivity rate o/38.5%. Preoperative CT scan was conclusive in 10 cases [including the five cases suggested by chest X-ray] with a sensitivity rate of 76.9%. There was a significant increase [X  =3.26, p<0.05] of diagnostic sensitivity with CT in comparison to chest x-ray. Concomitant injuries included liver laceration [n=2], splenic rupture [n=3], bowel injury [n=2], pelvic fractures [a = 4], rupture bladder [n=2], intracerebral hemorrhage [n=2] ; and traumatic left below knee amputation in one case, either as a solitary injury or in combination. In all cases the diaphragmatic defect was identifed, herniated organs were gently reduced and the diaphragmatic defect was repaired using monofilament non-absorbable sutures and chest cavity was drained. Abdominal exploration showed isolated diaphragmatic tear without herniating viscera in 3 [23.1%] cases, herniated stomach in 6 [46.2%] cases, herniated omentam in 3 [23.1%] cases, herniated dome of the right lobe of the liver in one [7.7%] case, herniated spleen in 3 [23.1%] cases and herniated colon in one [7.7%] case, either alone or in combination. Nine cases had linear diaphragmatic defect, 2 cases had a V-shaped defect, one case had irregular laceration of the diaphragmatic copula and one case had a Y-shaped defect. Two patients died throughout the postoperative follow-up period with a mortality rate of 15.4%. It could be concluded that TDR should be suspected in all thoraco abdominal trauma and to be looked for during surgical exploration irrespective of the results of preoperative investigations. Chest radiographs and helical CT are the best screening tests for diagnosis of TDR
Mahmoud M. El Gamal ,Mohamed Muharrm ,
Management of acute traumatic diaphragmatic rupture,
Benha Med. J. 2006;
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