ABSTRACT

Traumatic diaphragmatic rupture is a rare condition whose diagnosis is also difficult. High morbidity and mortality rates are seen. In our study we aimed to examine these cases in a 2 years period retrospectively to-gether with literature findings.

In our study 20 patients who were diagnosed and treated as traumatic diaphragmatic rupture between January 2009 and December 2011 were examined retrospectively. Patient age, gender, laboratory and radiologic findings, blunt or penetrating trauma ratio, diameter and localization of rupture, other organ lacerations, organ herniation, surgical procedure, hospitalization duration, mortality and morbidity were examined.

Seventeen of 20 traumatic rupture patients were male and 3 of them were women. Median age were 40.2 (20-76). Sventeen patients had blunt and 3 patients had penetrating trauma. Eight operated patients (40%) had ruptures diagnosed with chest X-Ray. Five patients (25%) were diagnosed with the help of thoracoabdominal CT. Four patients were operated on urgently. Total mortality was 7 (35%). Mean hospital-ization duration was 10.7±4.0 days. Fifteen patients had a left and 5 patients had right diaphragmatic rupture. Mean rupture diameter was 6.8±2.9 cm (2-12 cm). Only 6 patient ruptures were repaired singly. Four operated patients did not have any herniation (20%). Ruptures with organ herniations were as follows; omentum (35%), stomach (30%), spleen (30%), small bowel (15%) and colon (10%).

Diagnosis of diaphragmatic rupture is difficult. Many of the patients with rupture were unstable hemodynamically and there is usually little time for accurate diagnostic tests. Therefore, very few patients with blunt or penetrating trauma are also examined for a rupture.Intraoperative careful bilateral examination of the diaphragm is essential for reducing morbidity and mortality rates. (Gazi Med J 2012; 23: 51-4)