TS07
OUTCOME OF TRAUMATIC RUPTURE OF THE DIAPHRAGM (TRD)

• Published in: ANZ journal of surgery Vol. 77; no. s1; p. A94
• Main Authors: Goonewardene, K., Warwick, A. M., Burton, P. R., Brown, W. A.
• Format: Journal Article
• Language: English
• Published: Melbourne, Australia Blackwell Publishing Asia 01.05.2007
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/j.1445-2197.2007.04133_7.x

Purpose  TRD is an uncommon but serious consequence of blunt trauma. It is often associated with other life threatening injuries and its diagnosis is challenging. Limited information exists on outcomes following rupture, although there are increasing reports of late recurrent herniation. Our aim was to document the outcome of TRD initially and at intermediate term follow up (up to five years). Methodology  A review of all patients suffering TRD, over the past five years, at The Alfred Hospital was performed. Injury severity score (ISS), associated injuries, diagnosis‐ early versus late and imaging modality used, and surgical repair technique were recorded. All patients were followed up with a questionnaire, regarding symptoms of recurrence and chest X‐ray (CXR). Results  33 patients (18 female, 15 male; mean age 36 yrs, mean ISS 42) were included. All injury mechanisms were high energy (motor vehicle occupants 27, pedestrians 5, horse rider 1); 25 sustained other intra‐abdominal injuries. There were nine early and no late deaths. CXR was diagnostic in 14 cases, with 23 recognised early (pre‐operatively). 6 were diagnosed intra‐operatively (5 for instability, 1 following unremarkable imaging). 3 late diagnoses (>24 hours after presentation) occurred, with 1 at 6 months post injury. Emergent primary repair was undertaken using non‐absorbable sutures, although in three cases absorbable sutures were used. Conclusions  TRD is associated with high energy blunt force and severe multi‐system injury. We advocate emergent primary repair with non‐absorbable suture and advise a minimum five year follow‐up.