Traumatic diaphragmatic ruptures

Department of Surgery Nr. 1 “N. Anestiadi”, USMF “N. Testemitanu”, Laboratory of Hepato-Pancreato-Biliary Surgery, National Scientific and Practical Centre of Emergency Medicine, Chișinău, Republic of MoldovaIntroduction: Traumatic diaphragmatic ruptures (TDR) present significant diagnostic challenge and are potentially fatal. TDR are uncommon, the best majority being induced by blunt abdominal trauma, still these can be induced by abdominal, thoracic or thoraco-abdominal wounds. Material and Methods: During February 2012 - March 2014, in our department were treated 19 patients with TDR. Etiology, site and injury dimensions, ISS and RTS scores, method and treatment results were analyzed. Results: There were 16 (84.21%) males and 3 (15.79%) females, with the mean age 30.05±10.36 (95% Cl 25.06 - 35.04) years. Male: female ratio was 5.33:1. Blunt trauma was observed in 7 (36.84%), while wounds were diagnosed in 12 (63.16%) cases. The left diaphragm was injured in 12 (63.16%) and the right-one - in 7 (36.84%) cases. The mean injury size was7.5±6.1 (95% Cl 4.55-10.44) cm. Left-sided mean injury size was 6.41±5.39 cm (95% Cl 2.98-9.84), right-sided mean injury size was 5.5±6.69 cm (95% Cl - 0.68-11.69) (p=0.52). The mean ISS and RTS were 22.53±12.32 (95% Cl - 16.59-28.46) and 7.342±1.053 (95% Cl - 6.834-7.849) respectively. In 13 (68.42%) cases the diagnosis was established 24 h after admission. Preoperative TDR was diagnosed in 9 (47.36%) cases by thoraco-abdominal X-Ray and CT. In all the cases the lesions were sutured using permanent sutures (15 by laparotomy, 1 by right-sided thoracotomy, 1 laparoscopically, 1 by laprotomy with right-sided thoracotomy and 1 by laprotomy with left-sided thoracotomy). Postoperative death-rate was 1 (5.26%). Conclusions: The left part of the diaphragm is more frequently affected. Preoperative diagnosis is difficult