Abstract
Background and Objectives: Diaphragmatic ruptures are often associated with severe injuries. Delayed presentation can be life threatening due to organ herniation and strangulation. The aim of this descriptive study was to identify pitfalls in the diagnosis and treatment of diaphragmatic rupture.
Materials and Methods: Medical records of 117 patients admitted to Imam Khomeini hospital from 1994 to 2003 with diaphragmatic rupture were evaluated according to the type of injuries, diagnostic methods, associated organ injury, surgical findings, morbidity and mortality.
Results: Of patients with diaphragmatic rupture (101 male and 16 Female) 41 suffered from blunt trauma, 74 from penetrating injuries and 2 from iatrogenic traumas. With blunt trauma the rupture was in the left diaphragm in 73.2% 0f injuries, in the right diaphragm in 24.4% and bilateral in 2.4% of injuries. The diaphragm was delayed in 6 (5%) patients, 43 (37%) diaphragmatic ruptures were diagnosed before operation and 74 (63%) during operations. The most common associated injuries with diaphragmatic rupture were the liver (38.46%), spleen (35.04%) and colon (5.98%). Sixteen patients (14%) died due to accompanying injuries.
Conclusion: It is important to combine a high index of suspicion with radiological diagnostic tests in patient at risk. Palpation and/or visualization of diaphragm during laparotomy is extremely important in detecting these injuries when they are not under suspicion preoperatively