Rupture of the diaphragm – diagnostic pitfalls and methods of treatment

Czech version

Authors: M. Carda; J. Šiller; K. Havlíček; D. Kusý
Authors‘ workplace: The Institute of Medical Studies, The University of Pardubice ; Ústav zdravotnických studií, Univerzita Pardubice ; Traumacentre, The Surgical Dpt. of the General Hospital in Pardubice ; Traumatologické centrum, Chirurgická klinika KN Pardubice
Published in: Úraz chir. 13., 2005, č.3

Overview

The authors present outcomes of a study of their own collection of 18 patients with rupture of the diaphragm. Blunt injuries predominate in accord with the literature (94 %), in the overhelming majority of cases cause by traffic accidents (78 %). The left side of diaphragm was injured in 78 %, the right in 22 %. Diaphragm injuries was diagnosed late in four cases. One patient failed to seek medical attention immediately after the injury because of minor symptomatology, once diaphragm injury was not detected during urgent surgery and twice it was not picked up on primary Xray or CT. We can anticipate diaphragm rupture primarily in cases of injury to the left side of the torso in high energy traumas. Typically diaphragm rupture occurs in conjunction with rib fracture, injury to the spleen, left kidney, urinary bladder, pelvic fracture and fracture of the left humerus. Unidentified diaphragm rupture may lead to the risk of injury to prolapsing viscera by not properly indicated thoracic drain, strangulation of the prolapsing viscera and to compression of the intrathoracic organs. The standard treatment consists in laparotomy and suture of the diaphragm, which was used twelve times (67 %) by the authors. Thoracotomy is the prefered method for right sided and old ruptures. The diaphragmplasty using unresorbable mesh is reserved for old ruptures with defects (in this study used twice).

Key words:
diaphragm rupture, diagnostic, treatment.

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Labels

Surgery Traumatology Trauma surgery

Ipsilateral fractures of the proximal femur and the femoral shaft

Article was published in

Trauma Surgery

2005 Issue 3