Prognostic factors and outcome of traumatic diaphragmatic rupture

BACKGROUND
Traumatic diaphragmatic hernias commonly occur after blunt and penetrating trauma. The difficulties in diagnosing traumatic diaphragmatic rupture due to coexisting injuries and the silent nature of the diaphragmatic injuries at the first admission are the most common causes of delayed diagnosis.
METHODS
The medical records of 34 patients (28 male, 6 female; mean age 32.3 years; range 1 to 68) treated for post-traumatic diaphragmatic hernias between August 2004 and June 2008 in Alzahra Hospital were analyzed retrospectively.
RESULTS
Rupture of the diaphragm was left-sided in 22 (64.7%) and right-sided in 11 (32.4%) and bilateral in 1 (2.9%) of the patients. Blunt trauma accounted for the injuries of 22 patients (64.7%). In the first operation, diagnosis was established preoperatively in 15 patients (44.1%) and intraoperatively in 13 (38.2%). The diagnosis was missed in 6 (17.7%) patients in the first operation. Strangulation of the viscera was seen in three patients. The longest interval between the onset of trauma and diagnosis was approximately three years in one case. Multiple associated injuries were observed in 22 patients (64.7%), the most common of which were spleen injury (38.2%), fractures of the extremities and hemothorax (29.4%) and liver injury (26.5%). Postoperative complications were seen in nine patients (26.5%). Mortality of isolated blunt traumatic rupture was 0%. Hemorrhagic shock, young age and associated injuries significantly increased the mortality and morbidity.

CONCLUSION
Despite the fact that the incidence of diaphragmatic hernia is uncommon, it should be suspected in all blunt or penetrating traumas of the thorax and abdomen. Because late complications are usually associated with high morbidity, the presence of such an injury should be excluded before terminating the exploratory procedure.

Travmatik diyafragmatik rüptüründe prognostik faktörler ve sonuçlar

AMAÇ
Travmatik diyafragma fýtýklarý, künt ve penetran yaralanmalardan sonra sýklýkla oluþmaktadýr. Travmatik diyafragma yýrtýðý tanýsýnda zorluklar, eþlik eden yaralanmalar ve diyafragma yaralanmalarýnýn sessiz doðasý ilk baþvuruda geç taný konmasýnýn en sýk nedenleridir.
GEREÇ VE YÖNTEM
Alzahra Hastanesi’nde Aðustos 2004 ile Haziran 2008 tarihleri arasýnda post-travmatik diyafragma fýtýðý nedeniyle tedavi edilen 34 hastanýn (28 erkek, 6 kadýn; ortalama yaþ 32,3 yýl; daðýlým 1-68) týbbi kayýtlarý, retrospektif olarak incelendi.
BULGULAR
Diyafragma yýrtýðý hastalarýn 22’sinde (%64,7) sol tarafta, 11’inde (%32,4) sað tarafta ve 1’inde ise (%2,9) iki taraflýydý. Künt travma, 22 hastada yaralanma (%64,7) nedeniydi. Ýlk operasyonda taný, 15 hastada (%44,1) ameliyat öncesinde, 13 hastada (%38,2) ameliyat sýrasýnda koyuldu. Taný, 6 hastada (%17,7) ilk operasyonda atlandý. Üç hastada, viseral organ strangülasyonu görüldü. Travma baþlangýcý ile taný arasýndaki en uzun interval, bir olguda yaklaþýk üç yýl oldu. Hastalarýn 22’sinde (%64,7) eþlik eden birden çok sayýda yaralanma gözlendi ve bunlar en yaygýn olarak dalak yaralanmasý (%38,2), ekstremite kýrýklarý, hemotoraks (%29,4) ve karaciðer yaralanmasý (%26,5) þeklindeydi. Dokuz hastada (%26,5) ameliyat sonrasý komplikasyonlar gözlendi. Ýzole künt travmatik rüptür mortalitesi %0 oldu. Hemorajik þok, genç yaþ ve eþlik eden yaralanmalar, mortalite ve morbiditeyi anlamlý þekilde arttýrdý.
SONUÇ
Diyafragmatik fýtýk insidansýnýn nadir olmasý gerçeðine karþýn, toraks ve karýna iliþkin tüm künt ve penetran travmalarda diyafragma fýtýðýndan kuþkulanýlmalýdýr. Geç komplikasyonlarýn çoðunlukla yüksek morbidite ile birlikte olmasý nedeniyle, böyle bir yaralanmanýn varlýðý, tanýsal iþlemler tamamlanmadan önce ekarte edilmelidir.