[Clinical features of traumatic diaphragmatic injuries with or without herniated visceral organs]

The difficulty of diagnosis and selection of operative approach in traumatic diaphragmatic injuries (T. D.I.) have been debated for a long time. The reason why these problems remain unsolved is possibly due to the inaccuracy in the definition of T.D.I. We propose to classify the T.D.I. into two categories; diaphragmatic rupture without herniated visceral organs (D.R.) and diaphragmatic hernia with herniated visceral organs (D.H.). Clinical features in these two groups (D.R. in 9 cases and D.H. in 11 cases) were compared and discussed as follows: 1) Intrathoracic injuries were associated in all cases of both groups, but intraabdominal injury was found in 90.9% of D.H., whereas 33.3% of D.R. 2) Diagnostic findings in chest X-ray were not observed in D.R., but frequently observed in D.H. 3) All cases of D.R. were operated through a single approach (transabdominal or transthoracic), but additional approach was necessary in 78% of D.H. It is considered that T. D.I. should be classify into D.R. and D.H. because T.D.I. with or without herniated visceral organs exhibit definitely different clinical features.