Traumatic Diaphragmatic Injuries and Surgical Management
Summary
Traumatic diaphragmatic injuries arise most frequently from blunt or penetrating thoraco-abdominal trauma, with an incidence of up to 5 % in severe collisions. Clinical presentations range from occult defects to acute herniation of abdominal organs into the thoracic cavity, causing respiratory distress and visceral strangulation. Early diagnosis is challenging due to non-specific symptoms and coexisting injuries; computed tomography has emerged as the diagnostic gold standard for defining defect size, location and associated complications. Definitive management is surgical, with approach selection guided by haemodynamic stability, timing of presentation and defect characteristics. Minimally invasive repair via laparoscopy offers diagnostic precision and reduced morbidity in stable patients, while open laparotomy or thoracotomy remains crucial for unstable or complex cases. Biological and bioabsorbable meshes have lowered recurrence rates in large or chronic defects, and damage control surgery provides a staged framework for critically injured individuals. Advances in imaging, operative technique and biomaterials have collectively enhanced outcomes, emphasising the importance of multidisciplinary collaboration and protocol optimisation to mitigate morbidity and mortality on a global scale.
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Traumatic Diaphragmatic Injuries and Surgical Management publication trend
The graph below shows the total number of articles in traumatic diaphragmatic injuries and surgical management across all publications each year (not limited to Nature Index journals).
Technical terms
Diaphragmatic hernia: Protrusion of abdominal organs into the thoracic cavity through a defect in the diaphragm.
Laparoscopy: Minimally invasive surgical technique using small abdominal ports and a camera to visualise and repair intra-abdominal structures.
Laparotomy: Open surgical incision into the abdominal cavity, often employed in unstable trauma patients.
Thoracotomy: Surgical incision into the chest wall to access thoracic structures, indicated for acute or complex diaphragmatic injuries.
Damage Control Surgery: Abbreviated initial operation focused on controlling haemorrhage and contamination, with definitive repair deferred until physiological stabilisation.
Biological mesh: Implantable scaffold composed of acellular tissue matrix used to reinforce or replace compromised diaphragmatic tissue and reduce hernia recurrence.
References
- Management of complicated diaphragmatic hernia in the acute setting: a WSES position paper. World Journal of Emergency Surgery (2023).
- Acute and chronic traumatic diaphragmatic hernia: 10 years’ experience. PLOS ONE (2019).
- Thoracotomy compared to laparotomy in the traumatic diaphragmatic hernia. Systematic review and proportional methanalysis 1. Acta Cirúrgica Brasileira (2018).
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