Outcome of blunt diaphragmatic rupture. Analysis of 44 cases

To determine the predictors of outcome after blunt diaphragmatic rupture, the records of 44 patients aged 15-70 years (84.1% male) who underwent diaphragm repair between 1998 and 2007 were reviewed. There were 38 (86.4%) cases of acute diaphragmatic rupture and 6 (13.6%) of post-traumatic diaphragmatic hernia. The injury was left-sided in 30 (68.2%) patients, right-sided in 12 (27.3%), and bilateral in 2 (4.5%). The diagnosis of acute diaphragmatic rupture was made preoperatively in 28 (73.7%) patients and intraoperatively in 10 (26.3%). Repair was carried out through a thoracotomy in 31 cases, laparotomy in 4, and thoracolaparotomy in 3. The mortality rate after diaphragmatic rupture was 13.2% (5/38). The 33 survivors had a significantly younger mean age (37 vs. 57 years) and lower incidences of multiple injuries (36.4% vs. 100%) and shock (24.2% vs. 100%). Repair of diaphragmatic hernia was performed through a thoracotomy in all cases, with no mortality. It was concluded that age, associated severe multiple injuries, and clinical status were predictors of mortality after blunt diaphragmatic rupture.