Injuries to the Diaphragm

[dr-awale]

Diaphragmatic injuries (DI)-a frequent accompaniment of thoraco abdominal trauma  - remains a diagnostic challenge to surgeons and radiologists. (1-4)  Case reports and case series describe myriad ways in which this condition can present early, or in a delayed fashion following either blunt or penetrating trauma (5-9).  However it is important to recognize DI early because of the serious morbidity and mortality associated with missed DI.  For example, Degiannis reported 3% mortality for diaphragmatic injury diagnosed on a first admission, and 25% mortality for diaphragmatic injury diagnosed in a delayed fashion on the second admission after penetrating trauma in an African setting (10).  Following blunt trauma, delayed treatment of diaphragmatic injury carried a 10% mortality and a 30% major operative morbidity rate in a small series of ten patients (11)

This review will focus on the diagnosis and optimal management of this condition and offer recommendations for improved management in Africa.  Diaphragmatic injuries are common in African surgical practice because of the mixture of road traffic injury and penetrating injury seen at busy trauma centres
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