Traumatic diaphragma rupture: an experience of 13 cases

Diaphragmatic injury is a rare condition, but late diagnosis may be associated with increased mortality and morbidity. The aim of this study was to present our experience with the management of this injury. Between 2004 to 2007, 13 patients with traumatic diaphragmatic rupture or diaphragmatic hernia were treated. We described the findings in patients, who had operated urgent or had complaints due to intestinal obstruction months to years after an injury. All patients were male and mean age was 23.1 years. Diaphragmatic rupture was left-sided in all patients. Six of these patients had blunt and the remaining 7 had penetrating trauma. Diagnosis of diaphragmatic rupture was established in less than 24 hours in 4 patients. In the remaining 9 patients, who developed intra- throracic herniation of abdominal organs, diagnostic delay ranged from 12 to 48 months. The most frequent herniated organ was transverse colon. Non-absorbable sutures were used for closure of the defect. Complication rate was 30% and no death was observed. After blunt or penetrating trauma in upper abdomen and distal chest, a high index of suspicion is important to diagnose diaphragmatic rupture. Late presentations are associated with increased morbidity.