A retrospective Analysis of Presentations and Outcomes Traumatic Related Diaphragmatic injury Somalia: Single Center Experience

Background Traumatic diaphragmatic injury (TDI) is a rare condition easily missed in an acute clinical setting, resulting in subsequent life-threatening morbidity and mortality. The present is the first study aims to investigate the epidemiological and clinical characteristics and management outcome of blunt and penetrating TDI at a tertiary hospital in Somalia. Method This study included 105 patients with a TDI who underwent emergency or elective surgeries and were admitted to the hospital over four years. Demographic and clinical characteristics, mechanism of injury, concomitant injuries, management, and outcomes were reviewed. Results The prevalence of TDI was 7.2%, penetrating (75%), and blunt (25%). Among them, 83 (79%) were male, and 22 (21%) were female. The mean patient age was 36 ± 8.5. 725% occurred on the left side, while 25% were on the right. No cases of bilateral injuries were observed. Gunshot injury was the most common cause in 45% of the cases, followed by a stab wound in 20% and road traffic accidents in 15%. Penetrating trauma was experienced in 63% of young patients under 40, while blunt trauma was 42% in the same group (p < 0.002, 95% CI: 0.78–2.64). Eight patients presented late with diaphragmatic hernias; the most common were gastric and spleen. About 62.5% were admitted to the intensive care unit postoperatively. There was a high mortality rate (n = 18, 22.5%); 12 were men, and 8 were women. Patients with penetrating trauma had a greater mortality rate than blunt trauma patients (27.7% vs. 11.5%, p < 0.001, 95% CI: 0.92–4.06). Females had a higher mortality rate than males (57.7% vs. 15%, p < 0.023, 95% CI: 0.83–2.73). Conclusion Our study revealed a high prevalence and mortality rate of TDI due to gunshot and explosive injuries. Patients with hemodynamically unstable on admission, those with penetrating trauma, concomitant solid organ injury, and younger age have the highest morbidity and mortality. Our study noticed a higher rate of right-site involvement of TDI compared to the rates reported in the literature. Identifying and treating these patients is critical, yet most patients living in low-income countries face delays due to limited resources.