Traumatic diaphragmatic injury: A retrospective review of 14 cases managed at a regional hospital in Wolaita, Ethiopia

  • Carolyn Chew
  • Mehret Desalegn
  • Andrew Chew
Keywords: traumatic diaphragmatic injury, Ethiopia

Abstract

Background: Diaphragmatic injury from trauma is associated with significant morbidity and mortality. The incidence of trauma is increasing globally, leading to an increased number of diaphragmatic injuries. Diagnostic modalities may show indirect signs of injury and diagnosis requires a high index of suspicion. Definitive treatment involves surgical repair of the diaphragm. We aimed to describe traumatic diaphragmatic injuries managed at our hospital over a 3-year period.

Methods: In this retrospective case series, we reviewed diaphragmatic injuries managed between 1 June 2015 and 1 November 2018 at Soddo Christian Hospital in Wolaita Sodo, Ethiopia.

Results: Our case series included 14 cases, with predominance of males (92%, n=13). Almost half of the injuries were caused by road traffic injury (RTI) (42%). Seven patients had penetrating injuries (50%) and seven sustained blunt injuries (50%). The majority of penetrating injuries were secondary to assault, via firearm or stabbing (n=6). Ten patients presented to SCH directly from the site of injury, and two were transferred for further care from other institutions. Two patients presented with TDI more than 12 months following the initial injury. Of the acute patients who underwent preoperative imaging, chest X-Ray was diagnostic or suggestive of TDI in 70% of cases. CT scan was a useful adjunct in patients with diagnostic uncertainty. All of our patients were managed with surgical repair, and all acute trauma patients were managed via a trans-abdominal approach. Post-operative complications were seen in three patients. There were no mortalities within our case series.

Conclusions: Diaphragmatic injuries whilst uncommon is on the rise. A high index of suspicion, particularly in patients with blunt or penetrating thoraco-abdominal trauma is the most important tool. Whilst useful, CT scan is not essential for diagnosis in the majority of cases. Surgery is an effective treatment.

Published
2020-10-05
Section
Case Series