title: Traumatic diaphragmatic hernia: tertiary centre experience.
abstract: BACKGROUND
  Traumatic diaphragmatic hernia (TDH) resulting from traumatic diaphragmatic rupture (TDR) may not be easily detected and can lead to significant morbidity and mortality.
  
  
  METHODS
  A retrospective case note analysis was performed of all patients treated for TDR at a major teaching hospital between March 2003 and March 2008. The aetiological factors, associated injuries, management and outcome were analysed.
  
  
  RESULTS
  Twenty-seven patients were studied (24 males, 3 females) and their ages ranged from 16 to 72 years (median 35 years). TDR was left-sided in 85% and right-sided in 15%. Aetiology was blunt trauma in 81% and 19% had penetrating injury. Associated injuries were present in 81%. The most common approach for repair was transabdominal (89%); additional thoracotomy was needed in 11%. Herniation of abdominal contents was present in 85% and herniation of more than one organ was present in 57%. The diaphragmatic rent was repaired primarily in 89% using nonabsorbable sutures. Post-operative pulmonary complications occurred in 52% of patients. Three patients (11%) died.
  
  
  CONCLUSIONS
  Left-sided blunt traumatic diaphragmatic rupture was more common than right-sided rupture. The most commonly herniated organs were the stomach and colon. Most ruptures could be repaired by an abdominal approach, which also allowed a complete exploration of the abdominal organs. Careful attention should be given to associated intra-abdominal injuries. Most of the defects were repaired directly using nonabsorbable sutures.
authors.affiliation: Gastrointestinal Surgery Unit, Department of General Surgery, Postgraduate Institute of Medical Education and Research, 8H/5, Sector 12, PGI Campus, Chandigarh, 160012, India.
authors.forename: G S B
authors.initials: GS
authors.lastname: Kishore
authors.forename: V
authors.initials: V
authors.lastname: Gupta
authors.forename: R P
authors.initials: RP
authors.lastname: Doley
authors.forename: A
authors.initials: A
authors.lastname: Kudari
authors.forename: N
authors.initials: N
authors.lastname: Kalra
authors.forename: T D
authors.initials: TD
authors.lastname: Yadav
authors.forename: J D
authors.initials: JD
authors.lastname: Wig
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003287:Contrast Media; D005260:Female; D006549:Hernia, Diaphragmatic, Traumatic / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006784:Hospitals, Teaching; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013536:Suture Techniques; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media