Traumatic diaphragmatic ruptures: diagnostic and therapeutic approaches

Background: This study aims to evaluate the characteristics of patients with traumatic rupture of diaphragm (TDR), the diagnostic and therapeutic approaches used in these cases and and the outcomes of the patients. Methods: Forty-one patients (31 males, 10 females; mean age 41.9 years; range 7 to 71 years) with thoracoabdominal trauma and diagnosis of TDR who were treated in our clinic between January 2000 and January 2010 were analyzed retrospectively. The patients were statistically compared in terms of age, gender, the time of diagnosis (early or late), the diagnostic procedures that were performed, whether the diagnosis of rupture was made during or after the operation, the localization of the rupture, the diameter of the rupture, accompanying injuries, the surgery performed, mortality and morbidity and the trauma injury severity score. Results: The etiology for the diaphragmatic rupture was blunt trauma in 43.9% and penetrating trauma in 56.10% of the patients. 85.36% of the patients were diagnosed in early stage and 14.64% in late stage. Herniation dignosis was made radiologically in 118 (43.9%) patients and diaphragmatic rupture was detected during the operation in 23 patients (56.1%). Twenty-nine (70.73%) patients had thoracotomy, seven (17.02%) patients had laparatomy and five (12.19%) patients had thoracotomy plus laparatomy. The overall mortality rate was 14.63% (n=6). Conclusion: Traumatic diaphragmatic ruptures may have a fatal course depending on the strangulation of the herniating abdominal viscera. Traumatic diaphgram rupture should be suspected in all multitraumatic patients and these cases shuld be seriously evaluated for the definitive diagnosis and treatment plan.