Diaphragmatic rupture from blunt trauma

Records of 31 patients who sustained a ruptured diaphragm from blunt trauma form the basis for this report. There were 23 left-sided ruptures, one bilateral rupture, and seven right-sided ruptures. Viscus had herniated into the chest in 30 patients. Right-sided ruptures were associated with greater morbidity and mortality, mostly due to the more serious associated injuries. Chest roentgenograms were abnormal in all 31 patients; bowel could be seen in the chest in 11 patients. Pneumoperitoneum, upper gastrointestinal barium studies, and liver/spleen scans were all diagnostically helpful in selected patients. The correct diagnosis was made preoperatively in 25 of the 31 patients; one-third of all diagnoses were delayed. All exploratory laparotomies for blunt trauma should include careful inspection of the diaphragm, especially in the posterolateral region, and the area close to the esophageal hiatus to detect diaphragmatic rupture and prevent chronic herniations.