Rare Presentations and Repair of Delayed Traumatic Diaphragmatic Rupture: Report of 39 Cases Over 10 Years

Manouchehr Aghajanzadeh, Hossein Hemmati, Mohammad Sadegh Esmaeili Delshad, Piroze Samidost, Omid Mosaffaei and Elahe Rafiei

Department of Thoracic Surgery and General Surgery, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran Department of Inflammatory Respiratory Diseases and TB Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran

^*Correspondance to: Manouchehr Aghajanzadeh 

 PDF  Full Text DOI: 10.25107/2474-1647.1859

Abstract

Background: Diaphragmatic rupture is a life threatening condition, which may be due to severe penetrating or blunt trauma to the chest or abdomen. Considering that delayed diaphragmatic rupture has no clinical symptoms, results of diagnostic methods are restricted to the case report studies, also lack of early diagnosis of it in patients with multiple trauma and diversity of therapeutic methods, we decided to investigate the etiology, clinical symptoms, diagnostic and therapeutic methods of patients with delayed diaphragmatic rupture.Methods: In this retrospective study, we reviewed the data of all patients with diagnosis of delayed traumatic diaphragmatic rupture in surgical wards of Razi, Poursina and Aria hospitals of Rasht, Iran, between March 2006 and September 2016. Demographic and clinical data of patients were recorded. Finally, normality of the variables distribution was tested by using the one sample Kolmogorov-Smirnov test.Results: Patientsincluded in this study, 24 (61.5%) male and 15 (38.4%) female. The age of patientswas 10 to78 years old and the mean age was 38.84±18.54 years. Traffic crashes were the most common cause of traumatic diaphragmatic rupture in our study (41.0 %). Dyspnea was the most common symptom in our subjects (79.4%); Intestinal obstruction in 5 patients and Tension gasterothorax in 4 patients. 84.6% of our patients had right sided traumatic diaphragmatic rupture. The mean size of rupture in our subjects was 11.16±4.52 centimeters. Omentum was the most herniated organ (31.1%). Chest x-ray and computed tomography scan were used in all of our subjects for diagnosis of diaphragmatic rupture. The mean duration between trauma and surgery was 70.39±99.38 months. The mean duration of hospitalization was 7.92±5.05 days. The most common surgical method which was used for treatment of delayed diaphragmatic rupture in our patients was thoracotomy (74.3%). In the recent study, primary treatment of diaphragm was performed in 32 patients, partial mesh in 5 and complete mesh in 2 of patients.3 (5.2%) of our subjects died.Conclusion: Diagnosis of diaphragmatic rupture is difficult and has a clinical suspicion in high risk patients. So using of radiological modalities for diagnosis and treatment of it is necessary. Moreover, delayed diaphragmatic rupture and diaphragmatic hernia should be considered in patients with recent blunt trauma and gastrointestinal or respiratory complaints.

Keywords

Diaphragmatic rupture; Hernia; Traumatic; Mesh

Cite the article

Aghajanzadeh M, Hemmati H, Delshad MSE, Samidost P, Mosaffaei O, Rafiei E. Rare Presentations and Repair of Delayed Traumatic Diaphragmatic Rupture: Report of 39 Cases Over 10 Years. Clin Surg. 2018; 3: 1859.