Traumatic diaphragmatic disruption: a five-year experience at Spartanburg Regional Medical Center

Diagnosing diaphragmatic disruption requires a high level of suspicion. Diaphragmatic disruption must be considered in all cases of severe thoracoabdominal trauma. Initial chest x-rays can provide much useful information. Pathognomonic signs of diaphragmatic disruption on chest x-ray are stomach gas bubble in the chest, contrast material in the chest after its introduction into the upper gastrointestinal tract, and a nasogastric tube positioned above the diaphragm. In some cases a diaphragmatic disruption may not be diagnosed until exploratory laparotomy is done for associated injuries. One must carefully inspect both hemidiaphragms at the time of surgery, especially in injuries associated with penetrating trauma. Repair of the disruption should be undertaken at the time of diagnosis. The repair should be approached through a midline abdominal incision. A chest incision should be considered in cases of right-sided diaphragmatic disruption, or to assist with the delivery of contents back into the abdomen. Non-absorbable suture is recommended for all repairs of diaphragmatic disruption.