Acute diaphragmatic rupture after blunt trauma

In a retrospective analysis of 20 patients operated on for acute diaphragmatic rupture following blunt trauma, 85% of the patients presented with shortness of breath, and 85% had signs of peritoneal irritation or abdominal distension on physical examination. Preoperatively, a diaphragmatic rupture was diagnosed or suspected in 80%, and was based on chest X-ray examination alone or in combination with other radiological studies in all but one case. The diaphragmatic rupture was left-sided in 70%, right-sided in 20%, and bilateral in two cases. Intrathoracic herniation of abdominal organs occurred in 85% of the patients causing a strangulation of the stomach in one case. Three patients (15%) died from associated injuries, and all survivors had postoperative complications most commonly pulmonary. It is concluded that blunt trauma patients having respiratory distress and abdominal tenderness on admission should undergo a chest X-ray examination for suspected diaphragmatic rupture. Due to the high risk of organ herniation which can lead to strangulation, early diagnosis and operative management are important, and should not be overlooked in cases with associated injuries amenable to nonoperative management. Although the outcome is determined by the severity of associated injuries, prolonged post-operative ventilatory support may be required in about half of the patients.