[Rupture of the diaphragm--a frequently undetected injury]

Traumatic ruptures of the diaphragm are acquired separations of the diaphragm which are aetiologically divided into indirect and rare direct ruptures. The force required to produce indirect ruptures will usually lead to additional intraabdominal lesions of liver and spleen as well as to rib fractures and fractures at the lower extremity. Hence the sequels of these accompanying lesions are often prominent in the clinical pattern to such an extent that 50 to 70% of the diaphragmatic ruptures remain primarily unrecognised. Abdominal and/or cardiorespiratory signs and symptoms become manifest only if there is an evisceration. Hence surgical strategy in preoperatively identified diaphragmatic ruptures depends on the localisation of the rupture, on the severity of the accompanying lesions, and the time until surgical treatment can be effected. Depending on the type and severity of the accompanying lesions an average lethality of 33% must be taken into account in fresh diaphragmatic ruptures. In chronic uncomplicated eviscerations the operations lethality is about one per cent.