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. 2019 Dec 12;14(12):e0226364.
doi: 10.1371/journal.pone.0226364. eCollection 2019.

Acute and chronic traumatic diaphragmatic hernia: 10 years' experience

Pengcheng Gu  1 , Yang Lu  1 , Xigong Li  2 , Xiangjin Lin  1
Affiliations

Acute and chronic traumatic diaphragmatic hernia: 10 years' experience

Pengcheng Gu et al. PLoS One. .

Abstract

Controversy persists regarding many aspects of traumatic diaphragmatic hernia (TDH). We aimed to understand why some traumatic diaphragmatic injuries present with chronic hernia and to evaluate diagnosis and treatment options. Fifty acute and 19 chronic TDH patients were diagnosed and treated at our institution over a 10-year period. Clinical data from these two groups were analyzed statistically and compared. Chronic TDH patients had a significantly lower Injury Severity Score than acute TDH patients (10.26 ± 2.68 vs. 26.92 ± 4.79, P < 0.001). The most common surgical approach for acute and chronic TDH was thoracotomy and laparotomy, respectively. The length of the diaphragmatic rupture was significantly shorter in chronic TDH patients than acute TDH patients (6.00 ± 1.94 cm vs. 10.71 ± 3.30 cm, P < 0.001). The mean length of hospital stay was significantly longer for acute TDH patients than chronic TDH patients (41.18 ± 31.02 days vs. 16.65 ± 9.61 days, P = 0.002). In conclusion, milder trauma and a smaller diaphragmatic rupture were associated with delayed diagnosis. A thoraco-abdominal computed tomography scan is needed for patients with periphrenic injuries to avoid delayed diagnosis of TDH. Improved awareness and understanding of diaphragmatic injuries will increase the rate of early diagnosis and improve prognosis.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1
Pre-operative CR and CT (a, b and c) showed massive pleural effusion and the edge of the diaphragm was not clear; post-operative CR (d).
Fig 2
Fig 2
Pre-operative CR (a) showed right-sided TDH; post-operative CR (b).
See this image and copyright information in PMC

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