Management of traumatic diaphragmatic rupture.
OBJECTIVE
Diaphragmatic rupture following trauma is often an associated and missed injury. This report documents our experience of treating traumatic diaphragmatic rupture (TDR).


METHODS
We retrospectively analyzed 18 patients who presented between 1993 and 2000 with TDR, caused by blunt injuries in 14 and by penetrating injuries in 4.


RESULTS
The average age of the patients was 32 years and the female to male ratio was 4 : 14. The TDR was right-sided in 5 patients and left-sided in 13. The diagnosis was made by chest X-ray, thorax and upper abdominal computed tomography, and upper gastrointestinal contrast studies. The most common herniated organs were the omentum (n = 11), stomach (n = 10), spleen and colon (n = 9), and liver (n = 2). Sixteen diaphragmatic injuries were repaired primarily, and two were repaired using a prolene mesh graft. The mortality rate was 5.5% (n = 1).


CONCLUSIONS
A high index of suspicion and early surgical treatment determine the successful management of TDR, with or without the herniation of abdominal organs. The surgical approach to TDR is individualized. Acute left-sided injuries are best approached through the abdomen, although we prefer the chest approach, adding laparotomy when necessary. Acute right-sided injuries and chronic injuries should be approached through the chest.
Haciibrahimoglu
Gokhan
G
Department of Thoracic Surgery, Yedikule Hospital for Chest Disease and Thoracic Surgery, Istanbul, Turkey.
Solak
Okan
O
Olcmen
Aysun
A
Bedirhan
Mehmet Ali
MA
Solmazer
Nur
N
Gurses
Atilla
A
D000328:Adult; D003964:Diaphragm / Q000293:injuries*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012421:Rupture; D013898:Thoracic Injuries / Q000175:diagnosis / Q000601:surgery; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000601:surgery; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000601:surgery