Diaphragmatic Rupture Due to Blunt Trauma

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Abstract
We present an analysis of 42 cases of acute rupture of the diaphragm by blunt tauma. There were 31 men (74%) and 11 women (26%); the mean age was 32.8 years .+-. 2.4 SEM. At admission, hypovolemic shock was present n 45% of the cases, pelvic fracture in 36% and severe respiratory distress in 21%. Diaphragmatic rupture was suggested before operation by unilateral elevation of the diaphragm, supradiaphragmatic densities, and displacement of abdominal organs in the thorax, as shown by chest films and GI series in 18 cases (43%). The left hemidiaphragm was injured in 24 cases(57%) the right in 15 (36%), and both sides in three (7%). Of the 17 patients (40%) found to have an abdominal organ in the thorax, 12 had had a left-sided rupture. Only four patients (10%) had solitary diaphragmatic injuries. Associated injuries (usually two or more) occurred in 38 cases (90%);'' they were abdominal in 34, musculoskeletal in 26, neurologic in 16, and thoracic in nine. Theinjuries were repaired through a celiotomy in 33 cases, by thoractomy in six, and by separate celiotomy and thoracotomy in three. Postoperative complications occurred in 29 cases the most common being pulmonary (18), systemic sepsis (six), and recurrent bleeding (three). There were 14 deaths, for a mortality of 33%. Seven were operative and due to massive hemorrhage; the late deaths were caused by systemic sepsis in five neurologic trauma in two. We conclude that (12) diaphragmatic rupture after blunt trauma must be suspected when specific radiologic findings are present; (2) solitary diaphragmatic injuries seldom occur; (3) in most cases, morbidity or mortality is causedby the severity of the associated injuries; and (4) most diaphragmatic injuries can be repaired thorugh a celiotomy, and all of them should be repaired to avoid the sequela of entrapment of abdominal organs in the thorax.

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