Traumatic rupture of the diaphragm. Report of eleven cases

Rupture of the diaphragm is an unusual injury following blunt abdominal trauma. Due to its rather discrete initial symptoms, the diaphragmatic rupture is frequently overlooked in the acute stage. Of 11 patients operated on, only four ruptures were detected in association with the accident. The clinical picture was dominated by the patient's other injuries. Symptoms referable to the diaphragmatic rupture were pain in the upper abdomen and dyspnoea, especially in the recumbent position. The diagnosis was usually established by serial chest roentgenography, in a few cases supplemented by barium contrast studies, angiography or air insufflation in the abdomen (pneumoperitoneum). In the initial phase, an elevated and paradoxically moving diaphragm was usually seen on the injured side. Later, hermiation of viscera into the chest ensued, causeing respiratory impairment and, in about half of the cases, also gastro-intestinal disturbances. Early operation is advised in all cases of diaphragmatic rupture. Late complications are then avoided and the repair is technically easier to perform. In the presence of associated intra-abdominal injuries, e.g. rupture of the spleen, an abdominal incision is preferred. In isolated diaphragmatic ruptures, particularly in the late phase, the operation is more easily carried out through a low thoracotomy. The diaphragmatic rupture should be repaired with interrupted non-absorbable sutures--otherwise a risk of recurrence exists.