MISSED DIAPHRAGMATIC INJURIES AND THEIR LONG-TERM SEQUELAE

Background: Blunt or penetrating truncal traumas can result in diaphra gmatic rupture or injury, Because diaphragmatic defects are difficult to diagnose, those that are missed may present with latent symptoms of obstruction of herniated viscera. Methods: A chart review of all pati ents admitted with late presentations of postraumatic diaphragmatic he rnias from 1980 to 1996 was undertaken. Results: Ten patients with pos ttraumatic diaphragmatic hernias were treated in this specified period , There were six males and four females with a mean age of 65 years, E ight patients sustained blunt truncal traumas and two patients sustain ed penetrating truncal traumas, The hernias occurred in two patients o n the right and in eight patients on the left side and contained the l iver (n = 2), bowel (n = 10), stomach (n = 4), omentum (n = 5), or spl een (n = 1), The time until the hernias became clinically symptomatic ranged from 20 days to 28 years, In all but one patient, either routin e chest roentgenograms or upper gastrointestinal contrast studies were diagnostic, All 10 patients underwent laparotomy (n = 9) or thoracoto my (n = 2) with direct repair of the diaphragmatic defect. One patient died 3 days after the operation, representing a mortality of 10%; the morbidity was 30%. Conclusion: Initial recognition and treatment of d iaphragmatic rupture or injury is important in avoiding long-term sequ elae.