Delayed presentation of traumatic rupture of the diaphragm

Diaphragmatic injuries occur frequently after penetrating rather than blunt trauma and account for 8% of all organ injuries from penetrating trauma. Motor vehicle accidents account for approximately 50% of blunt injuries, followed in frequency by falls from height. The mechanism of injury in these accidents is that the body quickly decelerates while the organs continue to move downward or forward at maximal velocity, tearing vessels and tissues from their points of attachment. In this paper we are presenting 3 cases of traumatic diaphragmatic rupture due to motor vehicle accidents and fall from height, in which the diagnosis was delayed. Patient one was initially diagnosed with hemorrhagic pleural fluid for investigation, patient 2 was diagnosed 4 months later and patient 3 presented 7 years after the initial trauma. All were successfully treated surgically once the diagnosis was established.