Delayed traumatic rupture of the diaphragm in pregnancy

Traumatic rupture of the diaphragm may result from trauma or from direct penetrating injuries. The rupture is often an occult injury, which can have a symptom-free interval that may last for years. This paper presents the first 2 reported cases of delayed rupture associated with intrauterine pregnancy. A review of clinical signs and symptoms is presented along with typical radiological findings. Mortality in the nonpregnant state approaches 50% and varies directly with the number of organs involved, the presence of strangulation, and the interval of time from rupture to surgical intervention. The authors conclude that all obstetrical patients with a history of penetrating wounds of the chest or upper abdomen require special evaluation and prompt surgical intervention if delayed rupture of the diaphragm is established.