[Traumatic rupture of the diaphragm report of eleven cases (author's transl)]

This is a report of 11 cases of traumatic rupture of the diaphragm, 8 left, 2 right and 1 bilateral. In 10 cases the rupture occurred in multiple trauma victims of a violent accident. In one exceptional case a right rupture occurred after a minor trauma; it was followed by herniation of the right colon and half of tranverse, the liver remaining in the abdomen. The mechanisms and types of ruptures are analyzed. Early diagnosis is possible if one is conscious of the clinical signs in all cases of thoracic and abdominal trauma, and when correct and repeated roentgenograms are made of the thorax. If there is a doubt, digestive roentgenograms with contrast medium, pneumoperitoneum and a hepatic scintigram can confirm the diagnosis. In our cases diagnosis was set before operation 10 times in 11. Diaphragmatic rupture can cause serious complications: respiratory insufficiency, shock, intestinal occlusion and necrosis by strangulation. Operative indication is absolute as soon as the patient is out of shock, that the rupture be large or small, diagnosed early or late. The abdominal approach is best if operation is early, especially if one suspects associated abdominal lesions. Thoractomy is considered if the rupture is old. Mortality is not negligible (20%) partly because of associated fractures and visceral lesions.