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Traumatic rupture of diaphragm
R Shah1, S Sabanathan, A J Mearns
1Department of Thoracic Surgery, Bradford Royal Infirmary, United Kingdom.
The Annals of Thoracic Surgery
|November 1, 1995
Summary
Traumatic diaphragmatic rupture is a diagnostic challenge, often caused by blunt trauma. Early diagnosis improves outcomes, while delayed diagnosis of diaphragmatic hernia leads to complications.
Area of Science:
- Trauma surgery
- Thoracic surgery
- Diagnostic imaging
Background:
- Traumatic diaphragmatic rupture (TDR) presents diagnostic challenges.
- Associated injuries significantly impact patient outcomes.
- Latent cases of TDR can lead to diaphragmatic hernia with subsequent complications.
Purpose of the Study:
- To analyze clinical and radiologic features of traumatic diaphragmatic rupture.
- To evaluate therapeutic implications for managing TDR.
- To review a large cohort of TDR patients from English-language literature.
Main Methods:
- Systematic literature review of 980 patients with traumatic diaphragmatic rupture.
- Analysis of clinical presentation, injury mechanisms, and associated injuries.
- Evaluation of diagnostic timing, treatment approaches, and outcomes.
Main Results:
- TDR predominantly affects males (4:1 ratio) in their third decade, often due to blunt trauma (75%).
- Left-sided ruptures (68.5%) are most common, with chest (43.9%) and splenic (37.6%) trauma as frequent associated injuries.
- Diagnosis was preoperative in 43.5%, at exploration/autopsy in 41.3%, and delayed in 14.6%. Mortality was 17% for acute diagnoses; pulmonary complications were common in operated patients.
Conclusions:
- High index of suspicion, careful radiologic review, and diaphragmatic inspection are crucial for diagnosis.
- Acute diaphragmatic injuries are best managed via abdominal approach due to frequent intra-abdominal injuries.
- Latent diaphragmatic ruptures with adhesions require thoracotomy for optimal surgical management.