Diaphragmatic Injuries: A Frequent Missed Diagnosis in a Low Income Country

Objectives: To evaluate the current reported incidence of diaphragmatic injuries (DI) and to determine criteria that could help make the diagnosis of DI and improve its recognition in traumatised patients in Cameroon. Design: A retrospective study. Subjects: The cases of all diaphragmatic injuries repaired and diagnosed in two major hospitals in Cameroon. Setting: The General Hospital of Douala and the University Hospital centre of Younde, Cameroon. Results: During a ten-year period we have repaired eight diaphragmatic injuries. Five of them were consecutive to penetrating trauma and three after blunt trauma. All the patients were males. The mean age was 34. 5 years. Seven injuries occurred on the right side. The average Injury Severity Score was 37. 5 and all the patients had associated injuries to other organs. DI represents only 0.05% of all trauma cases. DI is underestimated in Cameroon and under diagnosed because physicians are not trained to think or to recognise it and autopsy is rarely performed after a traumatic death. Although there are no specific signs or symptoms, we have found some criteria which can raise suspicion of DI. Conclusion: Diaphragmatic injury is a very difficult diagnosis, and it is under diagnosed in Cameroon. We suspect that many patients severely injured may have associated DI which is not recognised and may contribute to increased mortality rate after major trauma