[Diagnostic problems in closed diaphragmatic ruptures]

These injuries are becoming more and more frequent and the prevalent etiological factor is the traffic accident. The isolated ruptures of the diaphragm are rare, while combined injuries of the organs (craniocerebral, the injuries of spine, pelvis, thorax and extremities) are more frequent. Left hemidiaphragm occurs more often than the right rupture. Clinical feature is a result of the prolapse of abdominal organs into the thorax. Apart from anamnesis and physical examination, radiological findings are the most important for diagnosing the rupture. Gastric tube and contrast medium are of considerable help. Pleural punction should be avoided because of possible complications, abdominal punction is helpful, whereas pneumoperitoneum is dangerous in the present respiratory insufficiency. If abdominal symptoms prevail, laparotomy is indicated: while in damages of thoracis organs and in neglected cases with large adhesions, thoracotomy is carried out. The prognosis depends on the injuries of other organs while in isolated diaphragmal ruptures death-rate is minimal (if diagnosis was made early). The authors present their experiences in the treatment of 30 patients during 16 years period (1972-1988).