Traumatic diaphragmatic rupture in children

The purpose of this study was to describe our experience with traumatic diaphragmatic rupture (TDR). Very little has been written about this condition in the pediatric age group.

Between January 2000 and December 2011, data on twenty-two patients with TDR were analyzed, and clinical data were recorded. The patients were divided into subgroups based on injury type and ISS values.

Four patients were female, and eighteen were male. Mean age was 9.4 years (range 2-15 years). TDR was left-sided in twenty (91%) patients and right-sided in two (9%). The mean ISS (Injury Severity Score) was 19 (range 11-29). No significant difference in morbidity was noted between firearm and other injuries (p=0.565) or between ISS values below and above 16 (p=0.565). Seven patients (32%) had isolated diaphragmatic injury, while the other fifteen cases had additional associated injuries. Diagnoses were determined via a chest radiograph alone in the majority of cases, while suspected cases were confirmed by multidetector computed tomography if the patients were hemodynamically stable. Herniation was observed in twenty patients. Primary suture of the diaphragm and tube thoracostomy were performed in all patients. Postoperative complications included ileus (two cases), intussusception (one case), empyema (one case), and one patient succumbed during the operation.

TDR, while uncommon, should be considered in cases of thoracoabdominal injury. All patients should undergo meticulous examination preoperatively. When the chest radiograph does not provide a definitive diagnosis, multidetector computed tomography, including multiplanar reconstruction or volume rendering, may be beneficial for confirming suspicion of diaphragmatic rupture.