title: Traumatic diaphragmatic injuries: epidemiological, diagnostic and therapeutic aspects.
abstract: BACKGROUND
  Diaphragmatic injuries include wounds and diaphragm ruptures, due to a thoracoabdominal blunt or penetrating traumas. Their incidence ranges between 0.8 and 15 %. The diagnosis is often delayed, despite several medical imaging techniques. The surgical management remains controversal, particularly for the choice of the surgical approach and technique. The mortality is mainly related to associated injuries. The aim of our study was to evaluate the incidence of diaphragmatic injuries occuring in thoraco-abdominal traumas, and to discuss their epidemiology, diagnosis and treatment.
  
  
  METHODS
  We performed a retrospective study over a period of 21 years, between January 1994 and June 2015 at the Department of General Surgery of the Aristide Le Dantec hospital in Dakar, Senegal. All patients diagnosed with diaphragmatic injuries were included in the study.
  
  
  RESULTS
  Over the study period, 1535 patients had a thoraco-abdominal trauma. There were 859 cases of blunt trauma, and 676 penetrating chest or abdominal trauma. Our study involved 20 cases of diaphragmatic injuries (1.3 %). The sex-ratio was 4. The mean age was 33 years. Brawls represented 83.3 % (17 cases). Stab attacks represented 60 % (12 cases). The incidence of diaphragmatic injury was 2.6 %. The wound was in the thorax in 60 % (seven cases). Chest radiography was contributory in 45 % (nine cases). The diagnosis of wounds or ruptures of the diaphragm was done preoperatively in 45 % (nine cases). The diaphragmatic wound was on the left side in 90 % (18 cases) and its mean size was 4.3 cm. The surgical procedure involved a reduction of herniated viscera and a suture of the diaphragm by "X" non absorbable points in 85 % (17 cases). A thoracic aspiration was performed in all patients. Morbidity rate was 10 % and mortality rate 5 %.
  
  
  CONCLUSIONS
  The diagnosis of diaphragmatic rupture and wounds remains difficult and often delayed. They should be kept in mind in any blunt or penetrating thoraco-abdominal trauma. Diaphragmatic lesions are usually located on the left side. Surgery is an efficient treatment.
authors.affiliation: General Surgery Department, Aristide Le Dantec Teaching Hospital, Dakar, Senegal.
authors.forename: Ousmane
authors.initials: O
authors.lastname: Thiam
authors.affiliation: Surgery and Surgical Specialties Department, Gaston Berger University, Saint-Louis, Senegal.
authors.forename: Ibrahima
authors.initials: I
authors.lastname: Konate
authors.affiliation: General Surgery Department, Aristide Le Dantec Teaching Hospital, Dakar, Senegal.
authors.forename: Mohamadou Lamine
authors.initials: ML
authors.lastname: Gueye
authors.affiliation: General Surgery Department, Aristide Le Dantec Teaching Hospital, Dakar, Senegal.
authors.forename: Alpha Omar
authors.initials: AO
authors.lastname: Toure
authors.affiliation: General Surgery Department, Aristide Le Dantec Teaching Hospital, Dakar, Senegal.
authors.forename: Mamadou
authors.initials: M
authors.lastname: Seck
authors.affiliation: General Surgery Department, Aristide Le Dantec Teaching Hospital, Dakar, Senegal.
authors.forename: Mamadou
authors.initials: M
authors.lastname: Cisse
authors.affiliation: General Surgery Department, Aristide Le Dantec Teaching Hospital, Dakar, Senegal.
authors.forename: Balla
authors.initials: B
authors.lastname: Diop
authors.affiliation: General Surgery Department, Aristide Le Dantec Teaching Hospital, Dakar, Senegal.
authors.forename: Elias Said
authors.initials: ES
authors.lastname: Dirie
authors.affiliation: General Surgery Department, Aristide Le Dantec Teaching Hospital, Dakar, Senegal.
authors.forename: Ousmane
authors.initials: O
authors.lastname: Ka
authors.affiliation: General Surgery Department, Aristide Le Dantec Teaching Hospital, Dakar, Senegal.
authors.forename: Mbaye
authors.initials: M
authors.lastname: Thiam
authors.affiliation: General Surgery Department, Aristide Le Dantec Teaching Hospital, Dakar, Senegal.
authors.forename: Madieng
authors.initials: M
authors.lastname: Dieng
authors.affiliation: General Surgery Department, Aristide Le Dantec Teaching Hospital, Dakar, Senegal.
authors.forename: Abdarahmane
authors.initials: A
authors.lastname: Dia
authors.affiliation: General Surgery Department, Aristide Le Dantec Teaching Hospital, Dakar, Senegal.
authors.forename: Cheikh Tidiane
authors.initials: CT
authors.lastname: Toure
keywords: Blunt abdominal trauma; Blunt chest trauma; Diaphragmatic hernia; Diaphragmatic injury