[Diaphragmatic traumatic hernia].
BACKGROUND
Traumatic diaphragmatic hernias commonly occur after blunt and penetrating trauma. Due to coexisting injuries and the silent nature of the diaphragmatic injuries, the diagnosis is easily missed. We undertook this study to describe the clinical characteristics of consecutive patients with traumatic diaphragmatic hernias treated surgically at our institution.


METHODS
We conducted a prospective cohort of patients treated during a 6-year period. We assessed variables such as age, gender, type of mechanism of trauma, type of hernia, methods of diagnosis, herniated organs and associated lesions, time of evolution, morbidity and mortality. Results are described as frequencies, dispersion and central tendency measures. Chi(2) and Fisher's exact tests were used to explore association and risks.


RESULTS
Twenty three patients were included, 19 men (82.6%) and 4 women (17.4%). Acute DTH were diagnosed in nine patients (39.1%) and 14 cases presented as chronic DTH (60.9%). In 18 cases (78.3%) the diagnosis was made by chest x-ray and most corresponded to chronic hernias. Medical history of blunt thoracoabominal trauma was present in 95.7% of the cases, most related to car accidents. The principal associated lesions were head injuries, rib fractures and lung contusion. morbidity was observed in six patients, all with chronic hernias. there was no mortality.


CONCLUSIONS
DTH is a rare clinical entity and constitutes a true challenge due to difficulties for a rapid and correct diagnosis. In the chronic stage there is an increased risk for late complications such as visceral strangulation and necrosis.
Olivares-Becerra
Juan José
JJ
Departamento de Cirugía General, UMAE Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México.
Farías-Llamas
Oscar Alejandro
OA
Candelas-del Toro
Omar
O
Medrano-Muñoz
Fabiola
F
Fuentes-Orozco
Clotilde
C
González-Ojeda
Alejandro
A
D000007:Abdominal Injuries / Q000453:epidemiology; D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002908:Chronic Disease; D015331:Cohort Studies; D015897:Comorbidity; D006259:Craniocerebral Trauma / Q000453:epidemiology; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology; D006549:Hernia, Diaphragmatic, Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D009104:Multiple Trauma / Q000453:epidemiology; D011446:Prospective Studies; D012120:Respiration Disorders / Q000209:etiology; D012253:Rib Fractures / Q000453:epidemiology; D013898:Thoracic Injuries / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000453:epidemiology