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Journal of Trauma and Injury 2012;25(4):217-222.
Management of Traumatic Diaphragmatic Rupture
Seon Hee Kim, Jeong Su Cho, Yeong Dae Kim, Ho Seok I, Seunghwan Song, Up Huh, Jae Hun Kim, Sung Jin Park
1Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, Korea. domini@pnu.edu
2Division of Traumatology and Acute Surgery, Pusan National University Hospital, Busan, Korea.
외상성 횡격막 손상의 치료
부산대학교 의과대학 흉부외과학교실, 1부산대학교 의과대학 외과학교실
Received: 13 November 2012   • Revised: 28 November 2012   • Accepted: 3 December 2012
Abstract
PURPOSE
Diaphragmatic rupture following trauma is often an associated and missed injury. This report is about our experience with treating traumatic diaphragmatic rupture (TDR).
METHODS
From January 2007 to September 2012, 18 patients who had a diaphragmatic rupture due to blunt trauma or penetrating injury underwent an operation for diaphragmatic rupture at our hospital. We retrospectively reviewed their medical records, including demographic factors, initial vital signs, associated injuries, interval between trauma and diagnosis, injured side of the diaphragm, diagnostic tools, surgical method or approaches, operative time, herniated organs, complications, and mortality.
RESULTS
The average age of the patients was 43 years, and 16 patients were male. Causes of trauma included motor vehicle crashes (n=7), falls (n=7), and stab wounds (n=5). The TDR was right-sided in 6 patients and left-sided in 12. The diagnosis was made by using a chest X-ray (n=3), and thorax or upper abdominal computed tomography (n=15). Ten(10) patients were diagnosed within 12 hours. A thoracotomy was performed in 8 patients, a video-assisted thoracoscopic surgery in 4 patients, a laparotomy in 3 patients, and a sternotomy in one patient. Herniated organs were the omentum (n=11), stomach (n=8), spleen and colon (n=6), and liver (n=6). Eighteen diaphragmatic injuries were repaired primarily. Seven patients underwent ventilator care, and two of them had pneumonia and acute respiratory distress syndrome. There were no operative mortalities.
CONCLUSION
Early diagnosis and surgical treatment determine the successful management of TDR with or without the herniation of abdominal organs. The surgical approach to TDR is chosen based on accompanying organ injuries and the injured side.
Key Words: Diaphragm; Rupture; Trauma; Thoracotomy


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