Acute traumatic diaphragmatic ruptures: A retrospective study of 48 cases

Traumatic diaphragmatic rupture (TDR) is associated with high rates of morbidity and mortality, and the preoperative diagnosis is difficult.

Forty-eight patients with TDR were treated in our department between January 2000 and May 2009. The cause, location, size of rupture, associated morbidity and mortality, surgical material for repair, and predictive factors for overall outcome were evaluated.

There were 41 male patients (85%) and 7 female patients (15%) with a mean age of 33.8 years (range 17-69 years). Blunt trauma accounted for the injuries of 15 patients (31%) and 33 patients (68%) had penetrating injuries. The diagnosis was preoperatively established in 12 patients (25%) with a plain chest X-ray or/and computed tomography. The location of rupture was on the left side of the diaphragm in 35 patients (73%), on the right side in 10 (21%), and was bilateral in 3 patients (6%). Traumatic diaphragmatic rupture was repaired with interrupted nonabsorbable sutures or polypropylene mesh (8 patients). Postoperative complications were observed in 18 patients (38%). Overall mortality was observed in 7 patients (15%). The mortality was associated with hemorrhagic shock (P = 0.002), a high injury severity score (P = 0.002), and having additional injuries (P = 0.015).

The outcome of the patients is associated with presence of hemorrhagic shock, a high injury severity score, and additional organ injury.