MANAGEMENT OF TRAUMATIC DIAPHRAGMATIC HERNIA – 13 YEAR EXPERIENCE OF A TERTIARY CARE CENTER

Abstract

Introduction- Blunt or penetrating trauma to the lower chest and abdomen can result into rupture of diaphragm and herniation. Sometimes, it is life threatening if herniation is massive causing cardiorespiratory compromise or strangulation of herniated contents. Early diagnosis and intervention is must to save the life. The purpose of this retrospective study was to nd out etiology, management, and outcome of traumatic diaphragmatic hernia at our center. Methods– we have retrospectively analyzed 49 patients of traumatic diaphragmatic hernia admitted in SMS Hospital Jaipur, Rajasthan, from June 2009 to June 2022. Analysis was done regarding age, gender, mode of injury, side of diaphragmatic injury, time to diagnosis, associated injuries, treatment and outcome. Results- The most common age group affected was 3rd decade (36%) and males (86%) outnumbered females (14%) with male to female ratio was 6:1. 88% patients suffered from blunt trauma while penetrating trauma was seen in 12% cases. Bullhorn injury, an unusual cause of injury, was noted in this study in 2 cases (4%). Left leaf of diaphragm (84%) was commonly injured than right leaf(16%). Thoracotomy was the preferred approach (69%) and laparotomy was done in 31% cases. Mortality rate was 6% in this series. Conclusion– Trauma to the lower chest and upper abdomen should raise the suspicion of diaphragm injury. Careful evaluation, routine radioghraphy, and intraoperative examination of diaphragm during any exploratory laparotomy or thoracotomy of trauma patients help in managing these cases timely with better results if not associated with severe cerebral and thoracoabdominal injuries.