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Traumatic diaphragmatic hernia: tertiary centre experience

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Abstract

Background

Traumatic diaphragmatic hernia (TDH) resulting from traumatic diaphragmatic rupture (TDR) may not be easily detected and can lead to significant morbidity and mortality.

Patients and methods

A retrospective case note analysis was performed of all patients treated for TDR at a major teaching hospital between March 2003 and March 2008. The aetiological factors, associated injuries, management and outcome were analysed.

Results

Twenty-seven patients were studied (24 males, 3 females) and their ages ranged from 16 to 72 years (median 35 years). TDR was left-sided in 85% and right-sided in 15%. Aetiology was blunt trauma in 81% and 19% had penetrating injury. Associated injuries were present in 81%. The most common approach for repair was transabdominal (89%); additional thoracotomy was needed in 11%. Herniation of abdominal contents was present in 85% and herniation of more than one organ was present in 57%. The diaphragmatic rent was repaired primarily in 89% using nonabsorbable sutures. Post-operative pulmonary complications occurred in 52% of patients. Three patients (11%) died.

Conclusion

Left-sided blunt traumatic diaphragmatic rupture was more common than right-sided rupture. The most commonly herniated organs were the stomach and colon. Most ruptures could be repaired by an abdominal approach, which also allowed a complete exploration of the abdominal organs. Careful attention should be given to associated intra-abdominal injuries. Most of the defects were repaired directly using nonabsorbable sutures.

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Authors and Affiliations

  1. Gastrointestinal Surgery Unit, Department of General Surgery, Postgraduate Institute of Medical Education and Research, 8H/5, Sector 12, PGI Campus, Chandigarh, 160012, India

    G. S. B. Kishore, V. Gupta, R. P. Doley, A. Kudari, T. D. Yadav & J. D. Wig

  2. Department of Radiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    N. Kalra

Authors
  1. G. S. B. Kishore
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  2. V. Gupta
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  3. R. P. Doley
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  4. A. Kudari
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  5. N. Kalra
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  6. T. D. Yadav
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  7. J. D. Wig
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Correspondence to J. D. Wig.

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Kishore, G.S.B., Gupta, V., Doley, R.P. et al. Traumatic diaphragmatic hernia: tertiary centre experience. Hernia 14, 159–164 (2010). https://doi.org/10.1007/s10029-009-0579-x

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  • DOI: https://doi.org/10.1007/s10029-009-0579-x

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