Traumatic diaphragmatic hernia—17 years experience

Abstract

Background

Objective of this study is to review our experience in the management of traumatic diaphragmatic hernias over 17 years.

Methods

Following Ethical Committee clearance, records of all patients who underwent traumatic diaphragmatic hernia surgery at Shanthabai Devarao Shivaram (SDS) Tuberculosis Research Centre and Rajiv Gandhi Institute of Chest Diseases, Bengaluru, India from January 1998 to December 2015 were reviewed. Data collected and analyzed were clinical presentation, mode of diagnosis, intraoperative findings and the postoperative clinical outcomes.

Results

Sixty patients underwent traumatic diaphragmatic hernia repair during this period. Age ranged between 10 and 80 years. The most common presentation was dyspnea. Blunt trauma was the cause in 52 (86.67%) cases and penetrating trauma in 8 (13.33%) cases. The diagnosis was within 24 h in 45 (75%) cases and in 15 (25%) cases the diagnosis was made after 24 h. Thoracotomy was the preferred approach for the repair in the absence of associated abdominal injuries. The most common site of rupture was the central tendon. The perioperative mortality was 8.33%. The hospital stay ranged between 5 and 84 days (mean 22 days).

Conclusion

Right-sided diaphragmatic hernias are notorious to be missed on initial evaluation. Despite advances in diagnostic modalities, chest X-ray still continues to be useful in the diagnosis of traumatic ruptures. A high index of suspicion, together with the knowledge of mechanism of trauma is the key factor for the correct diagnosis.

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