الفهرس 
INTRODUCTION& Aim of the workOnly 14 pages are availabe for public view
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Abstract
This study included 44 patients with diaphragmatic injuries, 33 males (75%) and 11 females (25%). Their ages ranged from 2 to 70 years with the largest number in the third decade of life. The causative trauma was blunt in 32 patients (72.7%) penetrating in 11 patients (25%) and iatrogenic following low insertion of chest tube in one patients (2.3%). Our patients were divided into 2 groups based on timing of presentation into acute and chronic. Acute patients were 27 (61.7%) who presented and were repaired within 2 weeks from time of trauma. The other 17 patients (38.6%) presented in the chronic phase. The presenting symptoms were mainly thoracic and abdominal. The presentation of acute patients was mainly dyspnea, chest pain and shock while that of chronic patients was abdominal, or thoracic but no shock. Detected signs on clinical examination were mainly diminished air entry in 38 patients (86.3%) and intestinal sounds within the chest in 12 patients (27.1%). In the acute group, we detected 6 stab wounds, 5 cripitus of fractured ribs, 3 bullet inlet and one patient with cyanosis. As regard side of injury, there were 30 patients (68.2%) on the left and 14 (31.8%) on the right with no bilateral or central diaphragmatic injuries. Plain chest X-rays was the simplest and most important method of diagnosis. It was diagnostic in 9 patients (20.4%), suspicious in 17 (38.7%), non specific in 9 (20.4%) and initially normal in 6 (13.6%). CT scan was diagnostic in 17 patients (38.7%) and gastrointestinal barium studies were diagnostic in 9 (20.4%). Twenty-seven patients showed associated injuries (61.4%), Twenty five out of them were acute cases. The most commonly encountered associated injuries were 9 hemothorax (20.4%), 8 fractured ribs (18.1%) and 7 extremity injuries (15.9%). Thirty-six patients (81.8%) showed herniation of abdominal organs into the chest. The most commonly herniated organ was the stomach which herniated in 17 patients (38.6%). Repair was done by nonabsorbable polypropylene interrupted suture in one layer which was reinforced by continuous layer of the same material in 42 patients (95.5%). In two patients, the defect was bridged by Dacron mesh. Postoperative complications were mainly abdominal distension in 6 patients (13.6%), prolonged tubal drainage in 4 (9.0%) and neurological complications in 2 (4.5%). From the study we conclude that: 1. Traumatic diaphragmatic injury is not infrequent, and needs high index of suspicion. 2. The presence of associated injuries is the rule and increases the suspicion for diaphragmatic injury, while in case of their absence, the condition can pass undetected to present latter on with symptoms of diaphragmatic hernia or strangulation. 3. The operative and postoperative complication in case of acute injury are related mainly to the effect of associated injuries while in chronic cases, are related to adhesions and compressive effect of herniated organs on the lung. 4. Once the diagnosis of diaphragmatic injury is established, surgical intervention should be instituted. 5. In acute cases, rout of repair is better to be thoracotomy in right side injury and laparotomy for left side injury. In chronic cases thoracotomy is the role. In general, thoracic surgeons prefer the thoracotomy approach.