Comparative outcomes of blunt and penetrating diaphragmatic ruptures: A single trauma center study.

Abstract

Objectives: Diaphragma rupture is an insidious case following thoracoabdominal trauma with significant morbidity and mortality rates, if left untreated. Its symptoms might be masked by other associated injuries, which are often present, especially following blunt trauma. Modern imaging modalities might overlook a present diaphragmatic rupture. The real challenge, therefore, lies in diagnosis rather than treatment. To shed more light on this entity, we shared our experience in this regard.

Material and methods: A total of 51 patients were enrolled in the study between January, 2008 and October, 2023, with a diagnosis of diaphragma rupture. Two groups were created, namely patients with blunt trauma (PwBT) and patients with penetrating trauma (PwPT). They were evaluated in terms of demographics, clinical and laboratory findings, trauma associated variables, mechanism of injury, accompanying injuries, imaging results, operative approaches and mortality rates.

Results: Mean age was 26 (22-33). 21.6% of the patients had blunt trauma. PwBT had significantly more extraabdominal site injuries and additional abdominal organ injuries (p <0.05). Glasgow coma scale and calculated revised trauma score values were significantly lower and injury severity scores values were significantly higher in PwBT (p <0.05). Significant thorax trauma accompanied 81.8% of PwBT and 40% of PwPT. Mortality was observed in 11.8% of the patients, with hemodynamic instability being the leading cause of death.

Conclusion: A trauma surgeon must exercise great caution not to overlook a diaphragma rupture following, especially, blunt thoracoabdominal trauma since it is both a consequence and reason of significantly increased mortality and morbidity rates. Future studies should focus on various aspects of both diagnosis and management of this entity, such as increasing the preoperative diagnosis accuracy and requirement of mesh usage during defect closure and optimal approach to especially right sided penetrating thoracoabdominal injuries.