Early diagnosis and surgical treatment of acute traumatic diaphragmatic rupture

Objective To summarize the clinical experiences of early diagnosis and treatment of traumatic diaphragmatic rupture(TDR). Methods The clinical data of 21 cases(18 males and 3 females) with traumatic diaphragmatic rupture in our hospital from April 2001 to November 2013 were retrospectively reviewed.These were composed of 13 cases with closed injury and 8 cases with opend injury.They were injured with sharp instrument injury(12 cases),injury caused by traffic accident(5 cases),iatrogenic injury(2 cases) and injury by fall(2 cases).Left-sided TDR was found in 17 patients,right in 4.Among all patients,complicating with diaphragmatic hemias(12 cases),traumatic shock(10 cases),hemopneumothorax(20 cases),pericardium rupture(5 cases),ventricle rupture(2 cases),injury of superior vena cava(1 case),laceration of lung(8 cases),gastric rupture(4 cases),hepatic rupture(4 cases),rupture of spleen(2 cases),rupture colonale(2 cases),serious craniocerebral injury(3 cases),spinal fracture(4 cases) and paraplegia(2 cases) were surgical treated.Computerized topography was performed preoperatively in 16 cases.All patients received operation,and selected laparotomy in 6 cases,thoracototomy incision in 7 cases,thoracolapara incision in 2 cases,video-assisted thoracoscopic surgery in 3 cases.The causes,diagnosis,emergency treatment and operation method are analyzed. Results TDR usually combined with chest visceral injury,and was complexity in clinical manifestation.Thirteen patients were definitely diagnosed before the surgery(positive rate 61.90%),and 8 patients including video-assisted thoracoscopic surgery in 3 cases were diagnosed definitely during the surgery.Eighteen patients were cured and 3 patients were died. Conclusion Raise awareness and emergency chest CT examination were major means of early diagnosis.The early diagnosis and actively surgical treatment in time of complicated injuries is the key to cure the traumatic diaphragmatic rupture.Video-assisted thoracoscopic surgery is the highest potential approach to manage TDR.