Approach to Traumatic Diaphragm Injuries: Single Center Experience

Traumatic diaphragm injuries are rare. After blunt trauma, injuries occur with a 1-7% rate. This rate increases up to 15% in penetrating injuries. Diagnosis may be diffi cult and imaging tests may be misleading. The misdiagnosis may lead to herniated abdominal organs towards the intrathoracic cavity, with a mortality rate between 30% and 60%. This study was designed to investigate the data of patients operated for diaphragmatic injury in our clinic.

The files of trauma patients admitted to our hospital between 2014-2019 were reviewed retrospectively. The files of cases with diaphragmatic injury were examined. Patients were evaluated in terms of age, sex, type of injury, localization, additional organ injuries, grade, surgical method, and mortality. Values were statistically analyzed.

A total of 20 patients were included in the study. Of the patients, 7 were female and 13 were male. The mean age was 32.7 (17-52) years. Of the cases, 10 were with stab wounds while 4 were incar traffi c accidents and 6 were gunshot wounds. Although all patients had thoracoabdominal injuries, 4 patients had additional pelvic injuries. Of the cases, 14 were accompanied with lung injury while 5 with intestinal, 4 with the spleen, 3 with liver, and 2 with cardiovascular injury. Patients with intestinal resection performed had a longer hospitalization period than others. When the severity of the injury was evaluated, grade 3 injuries were detected most commonly, whereas 3 patients had grade 1, 2, and 4 injuries. Grade 5 injury was detected in 1 patient. Primary repair was performed in 18 patients and mesh repair was performed in 2 patients. In three cases, the repair was performed with a thoracic way. One patient died on the postoperative fi rst day.

Diaphragmatic injuries that may be missed during imaging may be damaged with many organs. Diaphragmatic injuries should be kept in mind in the upper abdominal and thoracic injuries.