Thoracotomy for Traumatic Diaphragmatic Hernia

Area of Science:

• Trauma Surgery
• Thoracic Surgery
• Diagnostic Imaging

Background:

• Traumatic diaphragmatic hernia (TDH) is a severe injury often resulting from blunt trauma.
• Diagnosis of TDH can be delayed or missed due to subtle presentation and associated injuries.
• Thoracotomy is a surgical approach for TDH, but its efficacy and diagnostic role require review.

Purpose of the Study:

• To review the experience with diagnosis and the role of thoracotomy in managing traumatic diaphragmatic hernia (TDH).
• To analyze clinical features, imaging findings, operative details, and treatment outcomes for TDH patients.

Main Methods:

• Retrospective analysis of 23 patients who underwent thoracotomy for TDH between January 2008 and June 2014.
• Review of clinical data, including cause of injury, side of hernia, diagnostic methods (X-ray, CT), operative findings, and patient outcomes.
• Surgical repair of diaphragmatic defects using interrupted prolene sutures.

Main Results:

• Blunt trauma was the cause in 95.7% of cases, with left-sided TDH being more common (21/23 patients).
• Diagnosis relied on chest X-ray (2), CT scans (13), and high clinical suspicion at thoracotomy (8).
• Associated injuries were present in 91.3% of patients; mortality rate was 4.3%.

Conclusions:

• Traumatic diaphragmatic hernia diagnosis can be easily missed or delayed.
• Chest and abdominal CT scans are valuable tools for diagnosing diaphragmatic ruptures.
• Thoracotomy is an effective and successful treatment modality for traumatic diaphragmatic hernia.