Abstract
Objective: The aim of this prospective study is to highlight the incidence of a traumatic diaphragmatic rupture occurring in thoraco-abdominal penetrating or blunt trauma, and discuss their presentation and outcome Methods: We performed a prospective study, between 1st January 2017 to 30th June 2020 at the Department of General Surgery of the Al-Thawra Modern General Hospital, and 48-Modrn hospital -Sana'a city -Yemen. We included all the patients who were diagnosed and admitted with traumatic diaphragmatic rupture during the study period. Data included demographics, mechanism of injury, associated injuries, time of presentation post- trauma, length of hospital stay and ICU, ventilator days, management, postoperative complication, and outcomes. The variables were analyzed and compared for patients. Result: A total of 38 patients had traumatic diaphragmatic injury of (1843) thoracoabdominal trauma (2.1%)(855 blunt trauma & 988 penetrating trauma), 31 patients (81.6%) have sustained penetrating trauma, while only 7 patients (18.4%) have blunt trauma. There were 33 male patients (86.8%) and 5 female patients (13.2%) with a mean age of 25 years (range 3–52 years), the location of rupture was 30 patients (78.9%) on the left-sided, and 8 patients (21.1%) on right-sided, 4 patients presented early with a diaphragmatic hernia, and 5 patient presented late with diaphragmatic hernia. Associated injuries were presented in 36 patients (94.7%). The diagnosis was preoperatively established in (36.8%), and intraoperative (63.2%). The diaphragmatic rupture was repaired with interrupted nonabsorbable sutures. Postoperative complications were observed in 23 patients (60.5%). Mortality was observed in 4 patients (10.5%). The outcome affected by associated injuries hemo/pneumothorax, rib fractures/lung contusion, hollow viscous injury, post-operative complication, time of presentation post- trauma, and hemodynamically state before admission. Conclusion: Traumatic diaphragmatic rupture, usually masked by multiple associated injuries which aggravate the condition of patients and are responsible for morbidity and mortality. The left-sided is involved more than the right-sided.
Highlights
2.2 participants All patients admitted to the Al-Thawra Modern General Hospital, and 48 Modern hospitals, following injury by penetrating or blunt trauma to the thoracoabdominal area, the upper boundary of the fourth intercostal space, the sixth intercostal space, the eighth intercostal space and the lower edge of the ribs, during study period, all diagnosed diaphragmatic injury preoperative or intra- operative, were enrolled and included in the study
Thoracoabdominal contusion seen in seven cases post blunt trauma, the majority of wound post penetrating injuries of the thoracoabdominal area was on the lateral side below the level of 6 intercostal space 16 cases, 6 cases on the anterior side, and 9 cases on the back below the level of eight 8 intercostal space
Similar observation was reported by the current literature that suggests the proportion of blunt to penetrating trauma varies according to the regional characteristics and sociodemographic factors.(6)(20)(30) In the present study, 31 patients 81.6% of traumatic diaphragm injuries were associated with penetrating trauma, with the main cause of penetrating trauma being post bomb explosion injuries 14cases(45.2%), gunshot 10 cases (32.2%), and stab wound 7 case(22.5%), this agree with study reported by Mohi-Aldeen (29) the main cause was blast injury, and gunshot.Our results are different to those of other previously reported studies.(4)(20) (26) (27) were the main cause of penetrating trauma was stab wounds and gunshot
Summary
2.1 study design and setting Descriptive prospective study of patients with traumatic diaphragmatic injuries of all age groups and gender admitted to Al-Thawra Modern General Hospital, and 48 Modern hospitals, from 1st June 2017 to 30th June 2020 located in Sana'a city -Yemen. 2.2 participants All patients admitted to the Al-Thawra Modern General Hospital, and 48 Modern hospitals, following injury by penetrating or blunt trauma to the thoracoabdominal area, the upper boundary of the fourth intercostal space (anterior), the sixth intercostal space (lateral), the eighth intercostal space (posterior) and the lower edge of the ribs, during study period, all diagnosed diaphragmatic injury preoperative or intra- operative, were enrolled and included in the study. 2.3 Variables The variables studied included demographics, such as age and gender, time of presentation to hospital post- trauma (early or late), mechanism of injury, case of injury, anatomical sit of the external wound, associated organ injuries and it's management, time and mode of diagnosis, surgical approach and surgical technique, complication post-surgical operation and it's management, hospital length of stay, ICU length of stay, mechanical ventilator stay, and Outcome was measured by calculating (completely curd, mortality, and morbidity patients). A p-value of less than 0.05 was considered to be a statically significant
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