Traumatic diaphragmatic hernia: 28-years analysis at a Brazilian university hospital

Background: The objective of the study is evaluate the approach to patients with acute traumatic diaphragmatic hernia at a Brazilian university hospital during a 28-year period. Traumatic diaphragmatic hernia is an uncommon injury, however its real incidence may be higher than expected. Sometimes is missed in trauma patients, and is usually associated with significant morbidity and mortality, this analysis may improve outcomes for the trauma patient care. Methods: Retrospective study of time series using and analisys database records of trauma patients at HC- Unicamp was performed to investigate the incidence, trauma mechanism, diagnosis, herniated organs, associated injuries, trauma score, morbidity, and mortality of this injury. Results: Fifty-five cases were analyzed. Blunt trauma was two-fold frequent than penetrating trauma, are associated with high grade injury and motor vehicle collision was the most common mechanism. Left side hernia was four-fold frequent than right side. Diagnose was mostly performed by chest radiography (31 cases; 56%). Associated intra-abdominal injuries were found in 37 patients (67.3%) and extra-abdominal injuries in 35 cases (63.6%). The mortality was 20% (11 cases). Conclusions: Computed tomography scan identified associated injuries and had high specificity. Isolated injuries were rare, and the presence of associated injuries increased morbidity and mortality. Despite advances in imaging methods, chest radiography in the trauma bay is useful as an initial approach. Despite the use of laparoscopy in a few cases, laparotomy was the most frequent approach for repair.