MANAGEMENT OF TRAUMATIC DIAPHRAGMATIC HERNIAS

Objective: Experience with traumatic diaphragmatic hernias was reviewed to identify pitfalls in the diagnosis and treatment of this injury. Material and Methods: A Computerized chart review of all patients admitted to the Thoracic Trauma unit with traumatic diaphragmatic hernias was undertaken for the period of January 2001 to December 2007. Results: We retrospectively analyzed 18 patients who presented between January 2001 and December 2007 with traumatic diaphragmatic hernia, caused by blunt injuries in 15 (83.3%) and by penetrating injuries in 3 (16.7%). Average age of the patients was 30 years and the female to male ratio was 4:14. Traumatic diaphragmatic hernia was right-sided in 5 (27.8%) patients and left-sided in 13 (72.2%). The diagnosis was made by chest X-ray, thorax and upper abdominal computed tomography, and upper gastrointestinal contrast study. The most common herniated organs were omentum (n=11), stomach (n=10), spleen and colon (n=9), and liver (n=2). Sixteen diaphragmatic injuries were repaired primarily, and two were repaired using a prolene mesh graft. The mortality rate was 5.5% (n=1). Chest pain, abdominal pain, or dyspnea were the predominant symptoms. Conclusion: Careful history, use of good diagnostic tool, best approach and meticulous repair are important because of the frequency and severity of associated injuries.