Surgery in practice and science · 2026
Traumatic diaphragmatic hernia: A 38-case retrospective analysis of presentation and outcomes.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Xu Zhikai, Hou Chaoyao, Wang Chuntao
Аннотация
OBJECTIVE: Traumatic diaphragmatic hernia (TDH) is a life-threatening condition frequently missed due to concomitant injuries and nonspecific presentation. This study analyzes the clinical characteristics, diagnostic approaches, and surgical outcomes of TDH to improve early diagnosis and treatment.
METHODS: We conducted a retrospective review of all patients diagnosed with TDH at a tertiary trauma center between January 2017 and December 2023. Data extracted included demographic characteristics, injury mechanisms, clinical and imaging findings, surgical management, and postoperative outcomes.
RESULTS: Among 38 patients (30 males, 8 females; mean age 52.76 ± 13.52 years), motor vehicle collisions were the most common injury mechanism (63.2 %, 24/38). Left-sided TDH accounted for 86.8 % (33/38) of cases, with the stomach and colon being the most frequently herniated organs. Shock was present in 57.9 % (22/38) of patients upon admission. Common associated injuries included rib fractures (86.8 %, 33/38), myocardial contusion (68.4 %, 26/38), and splenic rupture (39.5 %, 15/38). The overall mortality rate was 13.2 % (5/38). Non-survivors had significantly lower Glasgow Coma Scale (GCS) scores (7.00 ± 3.00 vs. 11.30 ± 3.80, p=0.021) and higher Injury Severity Scores (ISS) (36.80 ± 3.83 vs. 29.91 ± 6.77, p=0.034) compared to survivors.
CONCLUSION: TDH is predominantly caused by high-energy trauma and is associated with a high incidence of polytrauma. A high index of suspicion, expedited computed tomography (CT) imaging, and prompt surgical intervention are critical. The transabdominal approach was the most frequently employed surgical technique, effectively addressing both diaphragmatic and associated abdominal injuries. Furthermore, we identified that the decision-making between open and minimally invasive approaches should be guided by hemodynamic stability, chronicity of the hernia, and the pattern of associated injuries.
METHODS: We conducted a retrospective review of all patients diagnosed with TDH at a tertiary trauma center between January 2017 and December 2023. Data extracted included demographic characteristics, injury mechanisms, clinical and imaging findings, surgical management, and postoperative outcomes.
RESULTS: Among 38 patients (30 males, 8 females; mean age 52.76 ± 13.52 years), motor vehicle collisions were the most common injury mechanism (63.2 %, 24/38). Left-sided TDH accounted for 86.8 % (33/38) of cases, with the stomach and colon being the most frequently herniated organs. Shock was present in 57.9 % (22/38) of patients upon admission. Common associated injuries included rib fractures (86.8 %, 33/38), myocardial contusion (68.4 %, 26/38), and splenic rupture (39.5 %, 15/38). The overall mortality rate was 13.2 % (5/38). Non-survivors had significantly lower Glasgow Coma Scale (GCS) scores (7.00 ± 3.00 vs. 11.30 ± 3.80, p=0.021) and higher Injury Severity Scores (ISS) (36.80 ± 3.83 vs. 29.91 ± 6.77, p=0.034) compared to survivors.
CONCLUSION: TDH is predominantly caused by high-energy trauma and is associated with a high incidence of polytrauma. A high index of suspicion, expedited computed tomography (CT) imaging, and prompt surgical intervention are critical. The transabdominal approach was the most frequently employed surgical technique, effectively addressing both diaphragmatic and associated abdominal injuries. Furthermore, we identified that the decision-making between open and minimally invasive approaches should be guided by hemodynamic stability, chronicity of the hernia, and the pattern of associated injuries.