Traumatic diaphragmatic hernia in a tertiary hospital in Benin City, Nigeria
Main Article Content
Abstract
Background: Traumatic diaphragmatic injuries are not commonly encountered in trauma. They are a marker of severe injury worse still with blunt mechanisms. Computed tomography scan is the imaging modality of choice in stable patients and treatment involves simple or mesh repair.
Aim: The aim of this study was to determine the pattern of presentation of diaphragmatic injuries at the University of Benin Teaching Hospital (UBTH), Benin City.
Methods: The data of patients with traumatic diaphragmatic injuries between 1st January 2020 and 31st December 2024 was collected retrospectively from retrieved patient records and analysed and results are presented.
Results: Of the 1785 patients with thoraco-abdominal trauma, 8 (0.4%) of them had diaphragmatic injuries. Six patients (75%) were males, and the mean age was 34.5 years (SD + 14.6). Blunt and penetrating mechanisms were implicated in 4 patients (50%) each. The penetrating mechanism was from gunshot in 3 patients (37.5%). Five patients had left sided diaphragmatic injury, 2 patients had right sided diaphragmatic injuries and 1 patient had bilateral injuries. The diagnosis of diaphragmatic injury was made intra-operatively at laparotomy for peritonitis in 4 patients (50%). The surgical approach was a laparotomy in 7 patients (87.5%), while only 1 patient (12.5%) had a left thoracotomy. Overall mortality was 25% (2 patients).
Conclusion: Traumatic diaphragmatic injuries present a diagnostic challenge and require an index of suspicion for diagnosis. Missed injuries lead to delayed presentation with gut herniation into the chest causing increased morbidity and mortality.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The journal grants the right to make small numbers of printed copies for their personal non-commercial use under Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported License.
References
1. Powers SK. Diaphragm function in health and disease. In: Ji LL, ed. The skeletal muscle: plasticity, degeneration and epigenetics. Advances in Experimental Medicine and Biology, vol 1478. Springer, Cham. 2025; 615 – 630.
2. Thiam O, Konate I, Gueye ML, Toure AO, Seck M, Cisse M, et al. Traumatic diaphragmatic injuries: epidemiological, diagnostic and therapeutic aspects. Springerplus 2016; 5(1):1614.
3. DeBarros M, Martin MJ. Penetrating traumatic diaphragmatic injuries. Curr Trauma Rep 2015; 1: 92-101.
4. Dwivedi S, Banode P, Gharde P, Bhatt M, Ratanlal Johrapurkar S. Treating traumatic injuries of the diaphragm. J Emerg Trauma Shock 2010; 3(2): 173-176.
5. Guth AA, Pachter HL, Kim U. Pitfalls in the diagnosis of blunt diaphragmatic injury. Am J Surg 1995; 170(1): 5-9.
6. Agrusa A, Romano G, Chianetta D, De Vita G, Frazzetta G, Di Buono G, et al. Right diaphragmatic injury and lacerated liver during a penetrating abdominal trauma: case report and brief literature review. World J Emerg Surg 2014; 9:33.
7. Panda A, Kumar A, Gamanagatti S, Patil A, Kumar S, Gupta A. Traumatic diaphragmatic injury: a review of CT signs and the difference between blunt and penetrating injury. Diagn Interv Radiol 2014;20(2):121-128.
8. Bosanquet D, Farboud A, Luckraz H. A review diaphragmatic injury. Respir Med CME 2009; 2 (1): 1-6.
9. Gao JM, Du DY, Li H, Liu CP, Liang SY, Xiao Q, et al. Traumatic diaphragmatic rupture with combined thoracoabdominal injuries: difference between penetrating and blunt injuries. Chin J Traumatol 2015; 18(1):21-26.
10. Shah R, Sabanathan S, Mearns AJ, Choudhury AK. Traumatic rupture of diaphragm. Ann Thorac Surg 1995; 60(5):1444-1449.
11. Hanna WC, Ferri LF, Fata P, Razek T, Mulder DS. The current status of traumatic diaphragmatic injury: lessons learned from 105 patients over 13 years. Ann Thorac Surg 2008; 85 (3): 1044-1048.
12. Shinjo T, Izawa Y, Yonekawa C, Matsumura T, Mato T. Characteristics, outcomes, and prognostic factors in patients with penetrating and blunt traumatic diaphragmatic injury: a nationwide retrospective cohort study in Japan. Int J Emerg Med 2025; 18(1):23.
13. Furák J, Athanassiadi K. Diaphragm and transdiaphragmatic injuries. J Thorac Dis 2019; 11(Suppl 2):S152-S157.
14. Bonatti M, Lombardo F, Vezzali N, Zamboni GA, Bonatti G. Blunt diaphragmatic lesions: imaging findings and pitfalls. World J Radiol 2016; 8(10): 819-828.
15. Okonta KE, Ekwunife CN, Okonta EM, Aghaji MAC. Management of traumatic diaphragmatic injury—a peep into bowel repair via thoracotomy. J West Afr Coll Surg 2022; 12(2): 53-57.
16. Simon LV, Lopez RA, Burns B. Diaphragm rupture. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2025.