INJURIES OF THE DIAPHRAGM

  • 1 January 1980
    • journal article
    • research article
    • Vol. 20  (7) , 587-592
Abstract
Diaphragm injuries in 86 patients occurring over a 10 yr period were retrospectively reviewed. Blunt trauma victims experienced injury on the right and left with nearly equal frequency, representing a strikingly different experience from those reporting before 1970 when left-sided injuries predominated. Patients'' complaints and physical findings were not reliable indicators of diaphragm injury but were usually manifestations of associated injury. For acute victims, 95% had other injuries. Routine chest X-rays were the most reliable diagnostic tools, yet these were normal in one-fourth of the patients. Diagnosis depends on a high index of suspicion before operation and careful inspection of the diaphragm at operation. Initial thoracotomy required subsequent laparotomy to complete management in 7 of 15; laparotomy required supplemental thoracotomy only once in 65 instances. The superior operative approach for right or left diaphragmatic injury is initial laparotomy.