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Published on: November 3, 2023
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Factors affecting mortality in traumatic diaphragm ruptures.
Serhat Tokgöz1, Muzaffer Akkoca1, Yasin Uçar1
1Department of General Surgery, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara-Turkey.
Summary
Traumatic diaphragm ruptures (TDR) are rare but can lead to severe complications if undiagnosed. High-energy thoracoabdominal trauma necessitates suspicion of TDR, with mortality linked to injury severity and associated organ damage.
Area of Science:
- Trauma Surgery
- Thoracic Surgery
- Surgical Critical Care
Background:
- Traumatic diaphragm ruptures (TDR) are uncommon injuries.
- Undiagnosed TDR can lead to severe late complications including herniation, strangulation, and infection.
- These late complications carry significant morbidity and mortality rates.
Purpose of the Study:
- To evaluate the epidemiology, clinical characteristics, diagnosis, and treatment of TDR in thoracoabdominal trauma.
- To identify factors influencing mortality in patients with TDR.
Main Methods:
- Retrospective analysis of 45 patients operated for TDR between January 2012 and December 2017.
- Data collected included demographics, injury type, diagnostic methods, concomitant injuries, operative details, and outcomes.
- Injury Severity Score (ISS) and Abbreviated Injury Scale (AIS) were calculated.
Main Results:
- TDR occurred in 45 of 1066 thoracoabdominal trauma patients.
- Penetrating trauma accounted for the majority of cases (32), followed by blunt (9) and iatrogenic (4) injuries.
- Common associated injuries included hemopneumothorax (70%), liver (43%), and spleen (32%) injuries.
- Mortality rate was 17% (7 patients), primarily due to hemorrhagic shock and multiorgan failure.
Conclusions:
- Diaphragm injuries should be suspected in high-energy blunt and penetrating thoracoabdominal traumas.
- Mortality is significantly associated with higher AIS, ISS, multiple organ injuries, and pneumohemothorax.
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