Diaphragmatic injuries: recognition and management in sixty-two patients

Between 1979 and 1989, 62 patients were treated for traumatic injury of the diaphragm. Forty-five had penetrating injuries following stab wounds or gunshot wounds, and 17 had diaphragmatic tears from motor-vehicle and auto-pedestrian accidents. Forty-one patients sustained left-sided injuries; 20 patients sustained right sided injuries; and one patient sustained bilateral ruptures. All patients underwent exploratory laparotomy and diagnosis was confirmed at surgery. Diaphragmatic injury was suspected in only 17 (27%) patients preoperatively. The chest radiograph showed nonspecific abnormalities in 48 (77%) patients and was diagnostic in 15 (24%) patients. Six patients had diagnostic peritoneal lavage; five were positive and one was negative. Computerized tomography (CT) of the lower thorax and abdomen was performed on 11 (18%) patients, but not one scan was diagnostic. Fluoroscopy in two patients was helpful. All patients had other associated injuries. The liver, spleen, or stomach were frequently injured in association with penetrating diaphragmatic lacerations. Bony fractures, splenic injuries, and head trauma were more commonly found with blunt diaphragmatic ruptures. The average hospital stay for the penetrating injuries was 11 days and for blunt trauma was 16 days. The operative mortalities was 2 per cent for penetrating injuries and 12 per cent for blunt injuries.