Outcome of blunt diaphragmatic rupture. Analysis of 44 cases.
To determine the predictors of outcome after blunt diaphragmatic rupture, the records of 44 patients aged 15-70 years (84.1% male) who underwent diaphragm repair between 1998 and 2007 were reviewed. There were 38 (86.4%) cases of acute diaphragmatic rupture and 6 (13.6%) of post-traumatic diaphragmatic hernia. The injury was left-sided in 30 (68.2%) patients, right-sided in 12 (27.3%), and bilateral in 2 (4.5%). The diagnosis of acute diaphragmatic rupture was made preoperatively in 28 (73.7%) patients and intraoperatively in 10 (26.3%). Repair was carried out through a thoracotomy in 31 cases, laparotomy in 4, and thoracolaparotomy in 3. The mortality rate after diaphragmatic rupture was 13.2% (5/38). The 33 survivors had a significantly younger mean age (37 vs. 57 years) and lower incidences of multiple injuries (36.4% vs. 100%) and shock (24.2% vs. 100%). Repair of diaphragmatic hernia was performed through a thoracotomy in all cases, with no mortality. It was concluded that age, associated severe multiple injuries, and clinical status were predictors of mortality after blunt diaphragmatic rupture.
Faculty of Medicine, Mansoura University, Mansoura, Egypt. dr.noureldin_noaman@yahoo.com
Noureldin Noaman
NN
Gwely
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D016009:Chi-Square Distribution; D003964:Diaphragm / Q000293:injuries / Q000601:surgery*; D004534:Egypt; D005260:Female; D006549:Hernia, Diaphragmatic, Traumatic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012421:Rupture; D012720:Severity of Illness Index; D013898:Thoracic Injuries / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D013908:Thoracotomy / Q000009:adverse effects / Q000401:mortality; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D055815:Young Adult