Sixty-three cases of traumatic injury of the diaphragm

In the examination of patients with severe thoracic and/or abdominal trauma not requiring surgical exploration, special attention should be given to signs of traumatic diaphragmatic herniation (TDH). We analysed the hospital records of 63 patients with traumatic injuries of the diaphragm. Of these patients, 39 had suffered a blunt trauma in a traffic accident, 21 penetrating trauma, and three had fallen from a great height. There were 51 patients (81 per cent) with left-sided diaphragmatic injuries, ten (16 per cent) with right-sided injuries, and in two patients (3 per cent) the injuries to the diaphragm were bilateral. There were 22 patients (35 per cent) who had intrathoracic migration of abdominal viscera. Surgical treatment was given in all cases. Twelve patients (19 per cent) died due to massive haemorrhage, neurological lesions, or septicaemia. Based on the literature and our own experience, we developed a diagnostic protocol for the management of diaphragmatic injuries. Chest radiographs should be made routinely. If diaphragmatic injury is suspected, ultrasound investigation must be performed. If the physician is still in doubt, computed tomography should be performed. At laparotomy, the diaphragm should always be thoroughly examined for lacerations.