title: Traumatic diaphragmatic rupture with combined thoracoabdominal injuries: Difference between penetrating and blunt injuries.
abstract: OBJECTIVE
  Traumatic diaphragmatic rupture (TDR) needs early diagnosis and operation. However, the early diagnosis is usually difficult, especially in the patients without diaphragmatic hernia. The objective of this study was to explore the early diagnosis and treatment of TDR.
  
  
  METHODS
  Data of 256 patients with TDR treated in our department between 1994 and 2013 were analyzed retrospectively regarding to the diagnostic methods, percentage of preoperative judgment, incidence of diaphragmatic hernia, surgical procedures and outcome, etc. Two groups were set up according to the mechanism of injury (blunt or penetrating).
  
  
  RESULTS
  Of 256 patients with a mean age of 32.4 years (9-84), 218 were male. The average ISS was 26.9 (13-66); and shock rate was 62.9%. There were 104 blunt injuries and 152 penetrating injuries. Preoperatively diagnostic rate was 90.4% in blunt injuries and 80.3% in penetrating, respectively, P < 0.05. The incidence of diaphragmatic hernia was 94.2% in blunt and 15.1% in penetrating respectively, P < 0.005. Thoracotomy was performed in 62 cases, laparotomy in 153, thoracotomy plus laparotomy in 29, and combined thoraco-laparotomy in 12. Overall mortality rate was 12.5% with the average ISS of 41.8; and it was 21.2% in blunt injuries and 6.6% in penetrating, respectively, P < 0.005. The main causes of death were hemorrhage and sepsis.
  
  
  CONCLUSIONS
  Diagnosis of blunt TDR can be easily obtained by radiograph or helical CT scan signs of diaphragmatic hernia. For penetrating TDR without hernia, "offside sign" is helpful as initial assessment. CT scan with coronal/sagittal reconstruction is an accurate technique for diagnosis. All TDR require operation. Penetrating injury has a relatively better prognosis.
authors.affiliation: Department of Traumatology, Chongqing Emergency Medical Center, Chongqing 400014, China.
authors.forename: Jin-Mou
authors.initials: JM
authors.lastname: Gao
authors.forename: Ding-Yuan
authors.initials: DY
authors.lastname: Du
authors.forename: Hui
authors.initials: H
authors.lastname: Li
authors.forename: Chao-Pu
authors.initials: CP
authors.lastname: Liu
authors.forename: Shao-Yong
authors.initials: SY
authors.lastname: Liang
authors.forename: Qiang
authors.initials: Q
authors.lastname: Xiao
authors.forename: Shan-Hong
authors.initials: SH
authors.lastname: Zhao
authors.forename: Jun
authors.initials: J
authors.lastname: Yang
authors.forename: Xi
authors.initials: X
authors.lastname: Lin
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003964:Diaphragm / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D012421:Rupture; D013898:Thoracic Injuries / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging*