Traumatic diaphragmatic hernia challenging diagnosis and early management

Abstract

Background

Early diagnosis and management of traumatic diaphragmatic hernia (TDH) can be challenging for the emergency department or the trauma surgeon, as these injuries are often clinically masked by other associated severe injuries.

Methods

We retrospectively reviewed data of 50 patients diagnosed with an acute traumatic hernia from September 2014 to September 2017.

Results

50 patients were included in this study. Blunt trauma was the main cause in 40 patients (80%) patients. TDH occurred more on the left side; in 72% of patients. The diagnosis was preoperative in 20 patients (40%). In our study, 74% of cases were repaired through abdominal approach and 26% patients through thoracic approach. Complications of TDH occurred in 30 patients (60%) and were mainly pneumonia in 16 patients (32%), only 8 patients (16%) died (6 patients of them had delayed referral and 3 patients of them had severe head injury).

Conclusions

TDH may be masked by associated injuries in multiple trauma patients and may lead to life-threatening intestinal and gastric strangulation. So, early diagnosis and treatment of TDH are important. Emergency physicians and trauma surgeon should maintain a high index of suspicion of TDH while dealing with patients assessed for abdominal or respiratory symptoms regardless the history of trauma was recent or delayed.