Traumatic diaphragmatic rupture: associated injuries and outcome

A retrospective case note analysis was performed on all patients treated fo r traumatic diaphragmatic rupture (TDR) at a major teaching hospital betwee n January 1990 and August 1998. Patients were identified from the prospecti vely maintained UK Trauma and Research Network Database. Of the 480 cases o f torso trauma admitted during the study period, 16 (3.3%) had TDR. Blunt t rauma accounted for 13 (81%) of the injuries. A radiological pre-operative diagnosis was made in 10 (62.5%) patients. Seven of these were made on init ial chest radiography, two on ultrasound scan and one on computed tomograph y. All patients underwent a midline laparotomy and TDR was subsequently dia gnosed at operation in 6 patients. The left hemidiaphragm was ruptured in 1 4 (87.5%) patients and there was visceral herniation in 8 (50%). Twelve pat ients with blunt trauma had associated abdominal and extra-abdominal injuri es, but only one of the three patients with penetrating trauma had other in juries. The median Injury Severity Score (range) was 21 (9-50). The median time (range) spent on the intensive care unit was 2 days (0-35 days). Pulmo nary complications occurred in 7 (44%) patients. Two (12.5%) patients died from associated head injuries. TDR results from blunt and penetrating torso trauma, is uncommon, rarely occurs in isolation and is associated with a h igh morbidity and mortality. A high index of suspicion makes early diagnosi s more likely as initial physical and radiological signs may be lacking.