Diagnosis, treatment, and management of traumatic diaphragmatic rupture: A multi-center study

This study aims to evaluate the diagnosis, surgical outcomes, and prognosis of patients with traumatic diaphragmatic rupture and discuss recent advancements in diagnostic technologies.

Between January 2014 and January 2024, a total of 35 patients (27 males, 8 females; mean age: 45.3±14.2 years; range, 13 to 68 years) who underwent diaphragmatic repair for traumatic diaphragmatic rupture in three centers were retrospectively analyzed. Data including demographic characteristics of the patients, medical history, type of trauma, clinical findings, diagnostic methods used preoperatively, preoperative interventions, the establishment of an intraoperative diagnosis, associated organ injuries, side of the diaphragmatic rupture, type of surgical procedure, postoperative complications, and length of hospital stay were recorded.

Among the cases, penetrating trauma was the most common mechanism (62.9%). Among the 25 patients who underwent computed tomography, a preoperative diagnosis of diaphragmatic rupture was established in 14 (56%). The median defect size in the diaphragm was 5.7 cm in blunt trauma cases and 4.04 cm in penetrating trauma cases. The morbidity rate was 40%, and the mortality rate was 5.7%. The length of hospital stays for the surgically treated patients ranged from 4 to 16 days. Comparing the laparotomy and thoracotomy groups, the laparotomy group had a longer hospital stay (p=0.017) and had statistically significant data in terms of participation in multidisciplinary surgery (p=0.001).

Diaphragmatic rupture should be considered in cases involving high-energy blunt trauma, particularly when multiple lower rib fractures, liver lacerations, or splenic lacerations are present, or in patients with a history of penetrating trauma to the thoracoabdominal region. As delays in diagnosis and treatment may increase morbidity and mortality, early recognition and prompt management are essential. The choice of surgical procedure should be guided by the presence or absence of concomitant injuries.