Missed Traumatic Diaphragmatic Hernia: Presentation and Outcome of Surgery

Abstract

Background: Diaphragmatic insults are the most frequently overlooked injuries in trauma patients. Sometimes it is difficult for trauma physicians to detect diaphragmatic injuries because they are clinically silent. Nevertheless, the precise determination of this hernia is crucial, as missed traumatic diaphragmatic hernia (MTDH) may lead to serious complications. Objective: To comprehend MTDH more readily regarding the presentation and evaluation of surgical management outcomes. Methods: All patients diagnosed with MTDH admitted to the emergency department for surgery at the period from January 2010 to March 2018 were included in the study. We evaluated our cases as regard age, gender, clinical presentation, type of trauma, time since trauma, site of the hernia, surgical technique, complications, and mortality. Results: 25 patients with MTDH were included, 76% were males, mean age was 33.3 years. 92% were left-sided, while 8% were right-sided. 56% of cases were detected within 20 to 40 years of age. Penetrating trauma was the cause in 76 % of cases, blunt trauma in 16%. The stomach and colon were the commonest herniated organs in 64% and 56 % respectively. Dyspnea, abdominal pain, and vomiting were the commonest presentation. Thoracotomy was performed in all patients. Chest infection, pneumonia, ARDS, and empyema were the commonest complications. 3 (12%) cases of mortality in our study. Conclusion: every effort should be done to detect diaphragmatic injury in trauma patients, and surgeons should have a high index of suspicion, for early diagnosis, to prevent complications with subsequent high morbidity and mortality.