Source: Annual Congress 2002 - Chest trauma, airways and miscellaneous

Abstract

Chronic diaphragmatic rupture is the herniation of the abdominal organs into the thoracic cavity through a diaphragmatic rupture that has been overlooked after a penetrating or blunt trauma.
We have operated on 43 patients with diaphragmatic rupture between 1991 and 2001 in our institution. Fourteen of them were diagnosed as chronic diaphragmatic rupture. The time delay between the trauma and the diagnosis of the diaphragmatic rupture varied from 3 years to 20 years. Male to female ratio was even and the median age was 52 years (range from 16 years to 73 years). Eleven of the ruptures were on the left, 3 were on the right. The common approach for all the patients was a posterolateral thoracotomy through 7th intercostal space. The abdominal vissera were returned to the abdomen from the chest and the hernia sac was excised. The diaphragm was primarily repeaired with permanent suture in 10 patients. In 3 patients, the defects were closed with polytetrafloroethylene (PTFE) membrane. In one of the patients the diaphragmatic defect was closed with permanent suture and PTFE membrane. We had one postoperative mortality (7%) and 4 patients had complications (morbidity was 28%).
In conclusion, a diaphragmatic rupture should abruptly be corrected at the time of diagnosis; after properly predicting the tolerance of the patient for the surgery.

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E. Sarica, E. Gulhan, A. Alper, S. Topcu, E. Aydin, E. Kisacik, C. Kurul, P. Y. Adams, I. Tastepe (Ankara, Turkey). Transthoracic approach for chronic diaphragmatic ruptures. Eur Respir J 2002; 20: Suppl. 38, 972

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