Diaphragmatic rupture due to blunt trauma: a limited series case report

Background
Traumatic diaphragmatic rupture is an uncommon but potentially serious injury. Over the last 2 decades, the prevalence of blunt trauma as a cause of diaphragmatic rupture has increased five-fold. Five such patients surgically treated in two hospitals from Iraq are described herein.
Methodology
A retrospective analysis.
Results
All patients were men with a mean age of 31.6 years (range: 26–40 years). The cases consisted of injury following road traffic accidents (=4) or falling from a height (=1). Time intervals between trauma and diagnosis were 2 h, 3 days, 3, 7 and 20 years. The diagnosis was based on clinical grounds besides plain chest radiography, contrast gastrography and abdominal ultrasonography. Computed tomography scan of the chest and abdomen was carried out twice, whereas oesophagogastrodudenoscopy was perfeormed once. Tube thoracostomy was placed twice but failed to drain significant blood and/or air. The tear involved the whole diaphragm in two cases, whereas it was 6–10 cm long in others. Three diaphragmatic tears were directly closed by thoracotomy, one by left thoracoabdominal approach and one by laparotomy. There were no complications, and all patients survived.
Conclusion
Chronic diaphragmatic ruptures are actually missed rather than late-presented. High clinical index is essential to early diagnosis and prompt treatment of traumatic diaphragmatic rupture.