TITLE:
Traumatic Diaphragmatic Injury at Gabriel Toure University Hospital, Mali
AUTHORS:
Amadou Traoré, Madiassa Konaté, Abdoulaye Diarra, Idrissa Tounkara, Mohamed Traoré, Arouna Doumbia, Amadou Bah, Boubacar Yoro Sidibé, Amadou Maïga, Tani Koné, Boubacar Karembé, Zakari Saye, Koniba Kéita, Yacouba Bouaré, Assitan Koné, Ibrahim Diakité, Lassana Kanté, Bakary Tientigui Dembélé, Alhassane Traoré, Adégné Togo
KEYWORDS:
Diaphragmatic Injury, Trauma, Surgery, Gabriel Toure
JOURNAL NAME:
Surgical Science,
Vol.13 No.3,
March
11,
2022
ABSTRACT: Traumatic diaphragmatic injury (TDI) is rare and is most often the result
of a traffic road accident (TRA) or an assault. We initiated this study with
the aims of determining the
epidemiological, clinical and therapeutic aspects of TDI at Gabriel Toure
University Hospital. This was a retrospective study from January 1999 to June
2021 that included all patients who presented a diaphragmatic injury
consecutive to abdominal and/or thoracic trauma. In 22 years and 6 months, 46 cases of TDI were collected. They
represented 0.17% of hospitalizations, 0.26% of surgical emergencies and 5.5%
of thoraco-abdominal traumas. The average age was 31.69 years with a sex
ratio of 3.2. Criminal stabbings accounted for 56.5% and TRA for 19.6%.
Penetrating injuries accounted for 78.3% of cases. The parietal lesion was
thoracic in 21 cases (45.7%), abdominal in 19 cases (41.3%) and
thoraco-abdominal in 6 cases (13%). The chest X-ray, performed in 15 patients,
showed an intrathoracic gas bubble (4 cases) and hemothorax (6 cases).
Diagnosis of diaphragmatic lesion was preoperative in 21.7% (10 cases). The diaphragmatic breach was on the
left side in 65.2% (30 cases) and the average size was 3.17 cm. Laparotomy was
performed in 89.1%, thoracotomy in 4.4% and thoraco-laparotomy in 6.5% of
cases. The surgical procedure consisted of reduction of the herniated viscera
in 15.2% (7 cases) and closure of the diaphragmatic breach with non-absorbable
sutures in 82.6% (36 cases). Chest tube
drainage was performed in 73.9%. The average length of hospital stay was 9.8
days. Mortality was 13.04%. Conclusion: Traumatic diaphragmatic injury is rare
but its frequency is increasing in our country. It most often affects the young
man victim of assault or TRA. This type of trauma is rarely isolated;
you have to think about it in case of any thoraco-abdominal trauma. The
treatment is surgical. The prognosis depends on the severity of the associated
lesions.