Traumatic rupture of the diaphragm. Review of 62 successive cases

From 1970 to 1987, 62 patients, suffering from traumatic rupture of the diaphragm, have been treated. In more than 75% of the cases, other severe post-traumatic associated lesions were noticed. In 54 cases these concerned blunt trauma, most of which were due to road accidents. There were 53 lesions of the left hemidiaphragm. Early diagnostics were made 40 times (i.e. within 24 hours after the accident). This is why it is all-important to correctly interpret the simple X-ray of thorax and abdomen, possibly after inserting a nasogastric tube. In general, exploration by laparotomy was preferred. Thoracolaparotomy or sternolaparotomy was only used in cases of thoracic or thoraco-abdominal injuries associated with important lesions at the lungs or the mediastinal organs; or in the case of long-standing ruptures accompanied by herniation of different organs. The total mortality rate was 21%. Death was due to hypovolemia, serious brain injuries or multiple organ failure (MOF) due to sepsis.