Abstract
Traumatic diaphragmatic injury (TDI) is rare and is most often the result of a traffic road accident (TRA) or an assault. We initiated this study with the aims of determining the epidemiological, clinical and therapeutic aspects of TDI at Gabriel Toure University Hospital. This was a retrospective study from January 1999 to June 2021 that included all patients who presented a diaphragmatic injury consecutive to abdominal and/or thoracic trauma. In 22 years and 6 months, 46 cases of TDI were collected. They represented 0.17% of hospitalizations, 0.26% of surgical emergencies and 5.5% of thoraco-abdominal traumas. The average age was 31.69 years with a sex ratio of 3.2. Criminal stabbings accounted for 56.5% and TRA for 19.6%. Penetrating injuries accounted for 78.3% of cases. The parietal lesion was thoracic in 21 cases (45.7%), abdominal in 19 cases (41.3%) and thoraco-abdominal in 6 cases (13%). The chest X-ray, performed in 15 patients, showed an intrathoracic gas bubble (4 cases) and hemothorax (6 cases). Diagnosis of diaphragmatic lesion was preoperative in 21.7% (10 cases). The diaphragmatic breach was on the left side in 65.2% (30 cases) and the average size was 3.17 cm. Laparotomy was performed in 89.1%, thoracotomy in 4.4% and thoraco-laparotomy in 6.5% of cases. The surgical procedure consisted of reduction of the herniated viscera in 15.2% (7 cases) and closure of the diaphragmatic breach with non-absorbable sutures in 82.6% (36 cases). Chest tube drainage was performed in 73.9%. The average length of hospital stay was 9.8 days. Mortality was 13.04%. Conclusion: Traumatic diaphragmatic injury is rare but its frequency is increasing in our country. It most often affects the young man victim of assault or TRA. This type of trauma is rarely isolated; you have to think about it in case of any thoraco-abdominal trauma. The treatment is surgical. The prognosis depends on the severity of the associated lesions.
Highlights
Traumatic diaphragmatic injury (TDI) is a rupture of diaphragmatic continuity, often associated with an intrathoracic herniation of abdominal viscera
This was a retrospective study from January 1999 to June 2021 that included all patients who presented a diaphragmatic injury consecutive to abdominal and/or thoracic trauma
Traumatic diaphragmatic injury is rare but its frequency is increasing in our country
Summary
Traumatic diaphragmatic injury (TDI) is a rupture of diaphragmatic continuity, often associated with an intrathoracic herniation of abdominal viscera. It is rare with an incidence that varies between 0.8% and 5% of abdominal and/or thoracic trauma [1]. TDIs are most often the result of a traffic road accident (TRA) or an assault by firearm or stab [2] [3]. The preoperative diagnosis of TDIs is a challenge due to the absence of specific symptoms. Computed tomography (CT-scan), which is the imaging of choice, is not always feasible in an emergency. Imaging visualizes the herniated organs but more difficultly the rupture itself. The discovery is often intraoperative (40%) or late (20%) [2]
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