PREVALANCE OF TRAUMATIC DIAPHRAGMATIC RUPTURE IN JAMMU REGION.

Abstract

Traumatic diaphragmatic rupture (TDR) is rare but potentially life threatening and its diagnosis requires a high index of suspension. A retrospective cross-sectional study of 1236 cases of torso trauma who were admitted in GMC Jammu in the emergency (over a period of around one year) was carried out. Out of 1236 patients included in the study,18 (1.45%) had traumatic diaphragmatic rupture. Hence, prevalence of traumatic diaphragmatic rupture is 1.45%. These patients included 6 females and 12 males and the median age was 32 years. Blunt trauma accounted for 16 (88.88%) cases while penetrating trauma was the cause in 2 (11.12%) patients. Of these 18 patients, 10 (55.55%) were the result of road traffic accidents while 8 (44.45%) were due to fall from height. One of the patients died in the post-operative period due to severe lung injury. Left hemidiaphragm was ruptured in 16 (88.88%) patients while 2 (11.12%) patients had rupture of right hemidiaphragm. A pre-operative diagnosis was made in about 17 (94.44%) cases. 3 (18%) cases were diagnosed on clinical examination, 8 (42%) cases were diagnosed by Chest X ray changes, 2 (12%) cases were diagnosed on Ultrasonography, 4 (20%) cases were diagnosed on CECT Chest imaging and one patient was diagnosed on laparoscopy. Most of the diaphragmatic rents were primarily repaired using non-absorbable monofilament sutures while in one patient, diaphragmatic rent was repaired using mesh as prosthesis. Traumatic diaphragmatic rupture (TDR) usually results from blunt or penetrating injuries, and is rarely iatrogenic. Knives, bullets and sharp edges of fractured ribs are the most common penetrating objects. Non-penetrating trauma on lower chest or upper abdomen due to road traffic accidents or fall from height are mostly responsible for blunt diaphragmatic injuries. TDR occurs in approximately 5% of patients with major blunt thoracoabdominal trauma, most of them on the left side and an early correct diagnosis is made in less than 50% of cases. The difficulty of the diagnosis and the high mortality and morbidity rates of the untreated cases make this clinical entity more important. Deformation sheer of diaphragm is thought to be an important factor in the pathogenesis of the condition after blunt trauma. The injury is, therefore, seen after high energy impact, especially side impact, and is usually associated with other serious and often life-threatening injuries. TDR is a marker of the severity of the trauma and is associated with rupture of other intra-abdominal organs mainly spleen, bowel and liver. Early diagnosis and repair of diaphragmatic rupture are needed to decrease the amount of fibrosis and to avoid visceral compromise due to thoracic herniation.  

Keywords: traumatic diaphragmatic rupture, retrospective, blunt trauma, ultrasonography, laparotomy, hemidiaphragm, road traffic accident, thoraco-abdominal injury, chest radiography