Acute and chronic traumatic diaphragmatic hernia: 10 years' experience.

Pengcheng Gu,Xiangjin Lin,Xigong Li,Yang Lu,Linda L. Maerz

doi:10.1371/journal.pone.0226364

Pengcheng Gu, Xiangjin Lin + Show 3 more

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https://doi.org/10.1371/journal.pone.0226364

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Abstract

Controversy persists regarding many aspects of traumatic diaphragmatic hernia (TDH). We aimed to understand why some traumatic diaphragmatic injuries present with chronic hernia and to evaluate diagnosis and treatment options. Fifty acute and 19 chronic TDH patients were diagnosed and treated at our institution over a 10-year period. Clinical data from these two groups were analyzed statistically and compared. Chronic TDH patients had a significantly lower Injury Severity Score than acute TDH patients (10.26 ± 2.68 vs. 26.92 ± 4.79, P < 0.001). The most common surgical approach for acute and chronic TDH was thoracotomy and laparotomy, respectively. The length of the diaphragmatic rupture was significantly shorter in chronic TDH patients than acute TDH patients (6.00 ± 1.94 cm vs. 10.71 ± 3.30 cm, P < 0.001). The mean length of hospital stay was significantly longer for acute TDH patients than chronic TDH patients (41.18 ± 31.02 days vs. 16.65 ± 9.61 days, P = 0.002). In conclusion, milder trauma and a smaller diaphragmatic rupture were associated with delayed diagnosis. A thoraco-abdominal computed tomography scan is needed for patients with periphrenic injuries to avoid delayed diagnosis of TDH. Improved awareness and understanding of diaphragmatic injuries will increase the rate of early diagnosis and improve prognosis.

Highlights

Traumatic diaphragmatic hernia (TDH) is an uncommon disease, encountered in 0.8% to 6% of blunt trauma and more than 17% of thoraco-abdominal-penetrating trauma.[1,2,3,4,5,6] In the acute phase, traumatic diaphragmatic hernia (TDH) is often coupled with other thoraco-abdominal, cerebral, or musculoskeletal injuries
Diagnoses were made by chest radiograph (CR), computed tomography (CT), and surgical exploration in 16, 28, and 6 patients, respectively
Leftsided TDH is more common than right-sided TDH, in particular in blunt-trauma victims, an equal incidence is observed in patients who die before receiving definitive medical care.[1, 13, 18, 19]

Summary

Introduction

Traumatic diaphragmatic hernia (TDH) is an uncommon disease, encountered in 0.8% to 6% of blunt trauma and more than 17% of thoraco-abdominal-penetrating trauma.[1,2,3,4,5,6] In the acute phase, TDH is often coupled with other thoraco-abdominal, cerebral, or musculoskeletal injuries These more severe comorbidities, rather than the diaphragmatic injury itself, are responsible for the poor prognosis.[2, 7, 8] In the chronic phase, the hernia may cause gut obstruction or have a pathological impact on the respiratory and circulatory systems, causing high morbidity and mortality.[9].

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