Diaphragmatic injuries

Abstract

This study seeks to define the clinical presentation, the usefulness of diagnostic tests, surgical management approach and outcome of treatment among patients with diaphragmatic injuries. One hundred and sixteen patients with diaphragmatic injuries were treated. This was 6.5 % o f 1,778 chest trauma patients. Eighty-four of these patients (6.8% ) were among 1230 patients who had blunt chest injury and the remaining 32 patients (5.8%) were among 548 patients who had penetrating chest injury. The commonest mechanisms of injury were motor vehicle accidents (48.8%) for blunt and gunshot wounds (56.3% ) for penetrating diaphragmatic injuries. The left diaphragm was most commonly involved (86.9% for blunt, 59.4 % for penetration), 12.5% of the patients with penetrating chest injury had bilateral diaphragmatic injuries. There were no bilateral diaphragmatic injuries amongst the patients with blunt chest injury. Chest radiographs gave a highly positive yield in the diagnosis of blunt diaphragmatic hernia s (67,9% ) while nonspecific chest radiological findings (59.4% ) were more common among those with penetrating injuries. In 57 patients (49.1% ) out o f 116, preoperative diagnosis o f diaphragmatic hernia was certain. In the remaining 59 patients (50.9%), diagnosis was intra operative (40 patients),or at postmortem ( 1 9 patients). Surgery was emergent in 69 patients (71.1%), semi emergent in 21 patients (21.6%) and elective in 7 patients (7.2%).