Traumatic diaphragmatic injuries: epidemiological, diagnostic and therapeutic aspects
Introduction: Diaphragmatic injuries include wounds and diaphragm ruptures, due to a thoracoabdominal blunt
or penetrating traumas. Their incidence ranges between 0.8 and 15 %. The diagnosis is often delayed, despite several
medical imaging techniques. The surgical management remains controversal, particularly for the choice of the surgical
approach and technique. The mortality is mainly related to associated injuries. The aim of our study was to evaluate
the incidence of diaphragmatic injuries occuring in thoraco-abdominal traumas, and to discuss their epidemiology,
diagnosis and treatment.
Patients and methods: We performed a retrospective study over a period of 21 years, between January 1994 and
June 2015 at the Department of General Surgery of the Aristide Le Dantec hospital in Dakar, Senegal. All patients diagnosed
with diaphragmatic injuries were included in the study.
Results: Over the study period, 1535 patients had a thoraco-abdominal trauma. There were 859 cases of blunt
trauma, and 676 penetrating chest or abdominal trauma. Our study involved 20 cases of diaphragmatic injuries
(1.3 %). The sex-ratio was 4. The mean age was 33 years. Brawls represented 83.3 % (17 cases). Stab attacks represented
60 % (12 cases). The incidence of diaphragmatic injury was 2.6 %. The wound was in the thorax in 60 % (seven cases).
Chest radiography was contributory in 45 % (nine cases). The diagnosis of wounds or ruptures of the diaphragm was
done preoperatively in 45 % (nine cases). The diaphragmatic wound was on the left side in 90 % (18 cases) and its
mean size was 4.3 cm. The surgical procedure involved a reduction of herniated viscera and a suture of the diaphragm
by “X” non absorbable points in 85 % (17 cases). A thoracic aspiration was performed in all patients. Morbidity rate was
10 % and mortality rate 5 %.
Conclusion: The diagnosis of diaphragmatic rupture and wounds remains difficult and often delayed. They should
be kept in mind in any blunt or penetrating thoraco-abdominal trauma. Diaphragmatic lesions are usually located on
the left side. Surgery is an efficient treatment.
Auteur(s) : Ousmane Thiam1*, Ibrahima Konate2, Mohamadou Lamine Gueye1, Alpha Omar Toure1, Mamadou Seck1, Mamadou Cisse1, Balla Diop1, Elias Said Dirie1, Ousmane
Pages : 1-6
Année de publication : 2016
Revue : SpringerPlus
Type : Article
Mise en ligne par : SECK Mamadou