title: Traumatic diaphragmatic rupture in children.
abstract: BACKGROUND
  The purpose of this study was to describe our experience with traumatic diaphragmatic rupture (TDR). Very little has been written about this condition in the pediatric age group.
  
  
  METHODS
  Between January 2000 and December 2011, data on twenty-two patients with TDR were analyzed, and clinical data were recorded. The patients were divided into subgroups based on injury type and ISS values.
  
  
  RESULTS
  Four patients were female, and eighteen were male. Mean age was 9.4 years (range 2-15 years). TDR was left-sided in twenty (91%) patients and right-sided in two (9%). The mean ISS (Injury Severity Score) was 19 (range 11-29). No significant difference in morbidity was noted between firearm and other injuries (p=0.565) or between ISS values below and above 16 (p=0.565). Seven patients (32%) had isolated diaphragmatic injury, while the other fifteen cases had additional associated injuries. Diagnoses were determined via a chest radiograph alone in the majority of cases, while suspected cases were confirmed by multidetector computed tomography if the patients were hemodynamically stable. Herniation was observed in twenty patients. Primary suture of the diaphragm and tube thoracostomy were performed in all patients. Postoperative complications included ileus (two cases), intussusception (one case), empyema (one case), and one patient succumbed during the operation.
  
  
  CONCLUSIONS
  TDR, while uncommon, should be considered in cases of thoracoabdominal injury. All patients should undergo meticulous examination preoperatively. When the chest radiograph does not provide a definitive diagnosis, multidetector computed tomography, including multiplanar reconstruction or volume rendering, may be beneficial for confirming suspicion of diaphragmatic rupture.
authors.affiliation: Dicle University Faculty of Medicine, Department of Pediatric Surgery, 21280, Diyarbakir, Turkey. Electronic address: m.hanifi-okur@hotmail.com.
authors.forename: Mehmet Hanifi
authors.initials: MH
authors.lastname: Okur
authors.affiliation: Dicle University Faculty of Medicine, Department of Pediatric Surgery, 21280, Diyarbakir, Turkey.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Uygun
authors.affiliation: Dicle University Faculty of Medicine, Department of Pediatric Surgery, 21280, Diyarbakir, Turkey.
authors.forename: Mehmet Serif
authors.initials: MS
authors.lastname: Arslan
authors.affiliation: Dicle University Faculty of Medicine, Department of Pediatric Surgery, 21280, Diyarbakir, Turkey.
authors.forename: Bahattin
authors.initials: B
authors.lastname: Aydogdu
authors.affiliation: Dicle University Faculty of Medicine, Department of General Surgery, 21280, Diyarbakir, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Turkoglu
authors.affiliation: Dicle University Faculty of Medicine Department of Radiology, 21280, Diyarbakir, Turkey.
authors.forename: Cemil
authors.initials: C
authors.lastname: Goya
authors.affiliation: Dicle University Faculty of Medicine, Department of Emergency Medicine, 21280, Diyarbakir, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Icen
authors.affiliation: Dicle University Faculty of Medicine, Department of Pediatric Surgery, 21280, Diyarbakir, Turkey.
authors.forename: Murat Kemal
authors.initials: MK
authors.lastname: Cigdem
authors.affiliation: Dicle University Faculty of Medicine, Department of Pediatric Surgery, 21280, Diyarbakir, Turkey.
authors.forename: Abdurrahman
authors.initials: A
authors.lastname: Onen
authors.affiliation: Dicle University Faculty of Medicine, Department of Pediatric Surgery, 21280, Diyarbakir, Turkey.
authors.forename: Selcuk
authors.initials: S
authors.lastname: Otcu
mesh_terms: D000007:Abdominal Injuries / Q000453:epidemiology / Q000601:surgery; D000293:Adolescent; D015505:Chest Tubes / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004653:Empyema / Q000453:epidemiology; D005260:Female; D006549:Hernia, Diaphragmatic, Traumatic / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D006801:Humans; D045823:Ileus / Q000453:epidemiology; D007443:Intussusception / Q000453:epidemiology; D007813:Laparotomy; D008297:Male; D061330:Multidetector Computed Tomography; D009104:Multiple Trauma / Q000453:epidemiology / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012421:Rupture / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery; D013270:Stomach / Q000293:injuries; D013536:Suture Techniques; D013898:Thoracic Injuries / Q000453:epidemiology / Q000601:surgery; D013907:Thoracostomy; D015599:Trauma Severity Indices; D014948:Wounds, Gunshot / Q000453:epidemiology / Q000601:surgery; D014949:Wounds, Nonpenetrating / Q000453:epidemiology / Q000601:surgery; D014950:Wounds, Penetrating / Q000453:epidemiology / Q000601:surgery
keywords: Children; Diaphragm rupture; Thoracoabdominal trauma