Emergency traumatic Diaphragmatic injuries in Benin city

Abstract

Diaphragmatic injuries (DI) frequently accompany thoracoabdominal trauma. The diagnosis remains a challenge to surgeons and radiologists worldwide but missed injuries to the diaphragm is associated with great morbidity and mortality. We aimed to determine the prevalence of this injury in acute trauma and in general present our institutions’s experience in a developing nation. Patients and Methods: This was a 3-year prospective study at the University of Benin Teaching Hospital-a referral trauma centre in Mid-Western Nigeria. Trauma laparotomy forms were completed for all adult patients who had laparotomy for trauma during the period, evaluating bio data, injury mechanism,New Injury Severity Score ( NISS), side of diaphragmatic injury, herniating structures, associated injuries and post operative complications. Results: There were 11395 major trauma (NISS ≥ 16) cases during the period with 148 trauma laparotomies. There were 20 cases of diaphragmatic injuries. The age range was 16-51 (27.1 ±8-9) years, NISS 18-52 (32.2±10) and M:F ratio was 9:1. There were 12 cases of penetrating trauma and 8 of blunt. The left hemidiaphragm was injured in 13 and the right in 7 cases. Interventions included 16 laparotomies and 4 thoracolaparotomies. Conclusion: Diaphragmatic injuries are not uncommon in Nigeria. In the face of limited resources a high index of suspicion remains the key to improved diagnosis of this condition.

Keywords: Diaphragm, trauma, Benin City, Nigeria, missed injury, herniation, accident, trauma laparotomy, index of suspicion.