Traumatic Diaphragmatic Injuries, A Hospital Based Study at Al-Yarmouk Teaching Hospital

Jasim Ahmed, Raid; Abid Hammoud, Haitham

	Traumatic Diaphragmatic Injuries, A Hospital Based Study at Al-Yarmouk Teaching Hospital
Medical Journal of Babylon
Article 1, Volume 12, Issue 2, 2015, Pages 428-436
Authors
Raid Jasim Ahmed; Haitham Abid Hammoud
Abstract
Traumatic Diaphragmatic injury [TDI] is not uncommon accompaniment to blunt or penetrating trauma to the abdomen or thorax; it may present acutely with hemodynamic and respiratory compromise and be associated with significant injury to other organs or may not be diagnosed at the initial trauma at all and later present as a diaphragmatic hernia. This study examines the incidence, site of injury, time of diagnosis, available diagnostic tools and surgical approaches used to treat these patients. A retrospective study of 67 patients proved to have TDI between February 2009 to February 2012 at Al-Yarmouk Teaching Hospital who have sustained blunt or penetrating trauma to chest and or abdomen. Out of 67 patients identified to have TDI, 51 patients [76 %] have sustained penetrating type of trauma, while only 16 patients [24%] have history of blunt trauma. Patients' age ranges between 5 – 67 years, median age is 32 years. Penetrating trauma is most common in males 39 patients [58.3%] in comparison to 12 females [17.9%] while in blunt trauma it was equal [11.9%]. Most penetrating TDI were on right side 23 patients [34%] while in blunt TDI left side 13 patients [19%]was most common. Abdominal visceral injuries were the most common, 52 patients [77.6%] followed by associated thoracic injuries 48 patients [71.6%]. Most cases of TDI were diagnosed preoperatively 49 patients [73.1%] while only 12 patients [17.9%] were diagnosed postoperatively and six patients [8.9%] were diagnosed later. Computerized Tomography was most helpful diagnostic radiological test in 12 patients [17.9%] while focused assessment with sonography in trauma [FAST] was the least helpful in diagnosing TDI 2 patients [3%]. Most cases 57 patients [85%] of TDI were repaired via abdominal approach. Most common morbidity was atelectasis in 16 patients [23.8%]. During whole study, five patients died [7.4%]. Morbidity was due to other associated injuries and hemorrhagic shock Preoperative diagnosis of TDI was made in a small number of patients by the surgical team by radiological studies.A better radiological interpretive skills by the surgical team might improve preoperative detection of TDI. Due to high incidence of associated abdominal injuries, most cases of TDI can be managed through abdominal approach. TDI alone is not a predictor of mortality rate; it is the severity of associated injuries that predict higher mortality.
Keywords
Diaphragm; Blunt; Penetrating; trauma; hernia; Abdominal; thoracic

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