Traumatic diaphragmatic hernia in a tertiary hospital in Benin City, Nigeria

Background: Traumatic diaphragmatic injuries are not commonly encountered in trauma. They are a marker of severe injury worse still with blunt mechanisms. Computed tomography scan is the imaging modality of choice in stable patients and treatment involves simple or mesh repair. Aim: The aim of this study was to determine the pattern of presentation of diaphragmatic injuries at the University of Benin Teaching Hospital (UBTH), Benin City. Methods: The data of patients with traumatic diaphragmatic injuries between 1st January 2020 and 31st December 2024 was collected retrospectively from retrieved patient records and analysed and results are presented. Results: Of the 1785 patients with thoraco-abdominal trauma, 8 (0.4%) of them had diaphragmatic injuries. Six patients (75%) were males, and the mean age was 34.5 years (SD + 14.6). Blunt and penetrating mechanisms were implicated in 4 patients (50%) each. The penetrating mechanism was from gunshot in 3 patients (37.5%). Five patients had left sided diaphragmatic injury, 2 patients had right sided diaphragmatic injuries and 1 patient had bilateral injuries. The diagnosis of diaphragmatic injury was made intra-operatively at laparotomy for peritonitis in 4 patients (50%). The surgical approach was a laparotomy in 7 patients (87.5%), while only 1 patient (12.5%) had a left thoracotomy. Overall mortality was 25% (2 patients). Conclusion: Traumatic diaphragmatic injuries present a diagnostic challenge and require an index of suspicion for diagnosis. Missed injuries lead to delayed presentation with gut herniation into the chest causing increased morbidity and mortality.