Penetrating injuries of the diaphragm

Thirty-two cases of penetrating injuries of the diaphragm are reviewed. The problems of clinical and radiological diagnosis are outlined and the pitfalls of barium contrast studies are illustrated. Thoracoscopy is advised in all cases seen within 24 hours of the injury. Surgical access via laparotomy is recommended in both acute and chronic cases and where additional thoracotomy is necessary, separate abdominal and thoracic incisions are advised. The presence of colonic injury is shown to increase the risk of both wound sepsis and empyema postoperatively, whilst other visceral injuries do not appear to affect postoperative morbidity.