Diaphragmatic injury - A clinical review

Objective: Recent experience at King Fahad Hospital of the University, Al-K hobar University, Kingdom of Saudi Arabia was reviewed to identify the pitf alls in the diagnosis of diaphragmatic injuries, and attempt to develop a s cheme by which early diagnosis is achieved in order to avoid the sequelae o f delayed presentations. Methods: A retrospective chart review of patients admitted to the surgical service, with the diagnosis of diaphragmatic injury was undertaken during t he period June 1994 through to June 1999. Results: The total number was 8 patients, and the age , ranged between 6-71 years. Of these patients 5 were diagnosed immediately post-traumatic, 2 wi th delayed presentation, and one with recurrent post-traumatic repair. This case was excluded. Six patients presented following blunt and one after pe netrating trauma. Rupture occurred Z mainly on the left dome of the diaphra gm in 5 patients and on the right in 2. Complications ranged from mild ches t symptoms to severe respiratory and multi-system involvement. Conclusion: Diaphragmatic injuries occurred in 2%-5% of multiple trauma vic tims. It is considered a predictor of serious associated injuries, However, as many as 10%-30% are missed during, the initial evaluation. A high index of suspicion is required, and judicious use of diagnostic aids should be e mployed to reach early diagnosis to avoid the sequelae of missed injuries.