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Peer-reviewedCC BYLangenbeck's archives of surgery

Traumatic diaphragmatic injuries in blunt and penetrating trauma in a European trauma centre.

  • Lasse Rehné Jensen1
  • Sarah Andresen2
  • Emma Possfelt-Møller2,3
  • Søren Steemann Rudolph4
  • Thomas Skaarup Kristensen5
  • Luit Penninga2,3,6,7
7 affiliations
  1. 1Department of Digestive Diseases, Transplantation and General Surgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark. [email protected].
  2. 2Department of Digestive Diseases, Transplantation and General Surgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
  3. 3Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
  4. 4Department of Anaesthesiology, Center of Head and Orthopaedics, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
  5. 5Department of Radiology, Center of Diagnostics, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
  6. 6Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark.
  7. 7Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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Abstract

Purpose

Traumatic diaphragmatic injury is an uncommon but clinically important consequence of thoracoabdominal trauma. Diagnosis remains challenging because imaging findings may be subtle. We aimed to describe the clinical characteristics, imaging findings, management, and outcomes of surgically confirmed traumatic diaphragmatic injuries treated at a European trauma centre.Methods

We conducted a retrospective descriptive case series including all patients with surgically confirmed traumatic diaphragmatic injury who underwent surgery between January 2019 and December 2023. Data included demographics, trauma characteristics, imaging findings, operative management, and postoperative outcomes.Results

Thirty-nine patients were included (median age 38 [IQR 22-55] years; 87% male); 29 (74%) sustained penetrating trauma and 10 (26%) blunt trauma. The median Injury Severity Score was 19 (IQR 14-31). Preoperative CT was performed in 35 patients (90%), and the diaphragmatic injury was reported on the initial CT in only 60% of these patients. Overall, 23 patients (59%) had extra-abdominal injuries, 12 (31%) experienced major complications (Clavien-Dindo > IIIa), and four (10%) died within 30 days. Patients with blunt trauma generally had greater injury severity, more associated injuries, and poorer outcomes than those with penetrating trauma.Conclusion

Traumatic diaphragmatic injury remains a challenging diagnosis. In this descriptive case series, the diaphragmatic injury was reported on the initial CT in only 60% of patients who underwent preoperative CT, highlighting the importance of maintaining a high index of suspicion and systematically evaluating the diaphragm during trauma CT interpretation. Larger prospective studies are needed to better define the diagnostic performance of modern CT and optimize management.

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Cite

BibTeXRIS
BibTeX
@article{jensen2026traumatic,
  title = {{Traumatic diaphragmatic injuries in blunt and penetrating trauma in a European trauma centre.}},
  author = {Lasse Rehné Jensen and Sarah Andresen and Emma Possfelt-Møller and Søren Steemann Rudolph and Thomas Skaarup Kristensen and Luit Penninga},
  journal = {Langenbeck's archives of surgery},
  year = {2026},
  month = aug,
  doi = {10.1007/s00423-026-04169-1},
  url = {https://europepmc.org/article/MED/42955115},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Traumatic diaphragmatic injuries in blunt and penetrating trauma in a European trauma centre.
AU  - Lasse Rehné Jensen
AU  - Sarah Andresen
AU  - Emma Possfelt-Møller
AU  - Søren Steemann Rudolph
AU  - Thomas Skaarup Kristensen
AU  - Luit Penninga
PY  - 2026
DA  - 2026/08/01
JO  - Langenbeck's archives of surgery
DO  - 10.1007/s00423-026-04169-1
UR  - https://europepmc.org/article/MED/42955115
AB  - Purpose  Traumatic diaphragmatic injury is an uncommon but clinically important consequence of thoracoabdominal trauma. Diagnosis remains challenging because imaging findings may be subtle. We aimed to describe the clinical characteristics, imaging findings, management, and outcomes of surgically confirmed traumatic diaphragmatic injuries treated at a European trauma centre.Methods  We conducted a retrospective descriptive case series including all patients with surgically confirmed traumatic diaphragmatic injury who underwent surgery between January 2019 and December 2023. Data included demographics, trauma characteristics, imaging findings, operative management, and postoperative outcomes.Results  Thirty-nine patients were included (median age 38 [IQR 22-55] years; 87% male); 29 (74%) sustained penetrating trauma and 10 (26%) blunt trauma. The median Injury Severity Score was 19 (IQR 14-31). Preoperative CT was performed in 35 patients (90%), and the diaphragmatic injury was reported on the initial CT in only 60% of these patients. Overall, 23 patients (59%) had extra-abdominal injuries, 12 (31%) experienced major complications (Clavien-Dindo > IIIa), and four (10%) died within 30 days. Patients with blunt trauma generally had greater injury severity, more associated injuries, and poorer outcomes than those with penetrating trauma.Conclusion  Traumatic diaphragmatic injury remains a challenging diagnosis. In this descriptive case series, the diaphragmatic injury was reported on the initial CT in only 60% of patients who underwent preoperative CT, highlighting the importance of maintaining a high index of suspicion and systematically evaluating the diaphragm during trauma CT interpretation. Larger prospective studies are needed to better define the diagnostic performance of modern CT and optimize management.
SN  - 1435-2443
SN  - 1435-2451
ER  -