Open AccessDiaphragmatic injuries, a retrospective analysis of 50 patients
Author(s) -
Aamir Bilal,
Muhammad Salim,
Tahira Nishtar,
Shoaib Nabi,
Muhammad Muslim,
Manzoor Ahmed,
Gohar Ali,
Shehzad Cheema
Publication year - 2016
Publication title -
annals of king edward medical university
Language(s) - English
Resource type - Journals
eISSN - 2079-7192
pISSN - 2079-0694
DOI - 10.21649/akemu.v11i4.1074
Subject(s) - medicine , diaphragmatic breathing , thoracotomy , surgery , respiratory distress , retrospective cohort study , blunt , diaphragmatic rupture , chest injury , mortality rate , diaphragmatic hernia , hernia , alternative medicine , pathology
Objective:: This study seeks to define the clinical presentation, the usefulness of diagnostic tests, surgical management approach and outcome of treatment of diaphragmatic injuries in our trauma patients. Design:: An observational descriptive study. Place and duration of study:: Department of Cardiothoracic Surgery, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar from March 2001 to April 2005. Subjects and methods: In this retrospective study, 50 patients admitted to our department with diaphragmatic injury were evaluated according to the type of injury, diagnostic methods, associated organ injury, treatment, modality, morbidity and mortality. Results: The average age of patients was 32 years. There were 35 (70%) male and 15 (30%0 female patients, 38 (76%) of these patients sustained blunt and 12 (24%) had penetrating chest injury. The diaphragmatic injury was right sided in 4 and left sided in 46 patients. Thirty nine (78%) patients presented in respiratory distress within 48 hours of in jury while 11 (22%) presented with bowel obstructive symptoms months and years after injury. A chest x-ray on admission suggested the diagnosis in 70% of the cases while chest ultrasonography and contrast studies were required in others. Surgery was emergent in 35 (70%), semi-emergent in 9 (18%) and effective in 6 (12%) cases. Surgical approaches were left thoracotomy (40 patients), left thoracolaprotomy (6 patients) and right thoracotomy (4 patients). The diaphragmatic repair was achieved by direct suture in 45 cases while prolene Mesh was required in 5 cases. The mortality rate was 6% (n = 3). Recurrence occurred in one (2%), wound infection in 3 (6%), pleural, space, problem in 1 and chest infection in 2 (4%) patients. Conclusion: A high index of suspicion and early surgical treatment determine the successful management of traumatic diaphragmatic injury with or without the herniation of abdominal organs. The surgical approach is individualized. We prefer the thoracic approach adding laporotomy when necess ary.