[The diagnostic and treatment problems in closed diaphragmatic trauma]

Twenty four patients with blunt trauma of the diaphragm comprise the study group. Four of them died of accompanying injuries in other anatomical regions. All patients had the left leaf of the diaphragm affected. Laceration was most frequently radial in the area of centrum tendineum or in the transition area to pars muscularis. In left-sided ruptures of the diaphragm protruded usually the stomach, left colon, spleen, omentum majus and seldomer small intestines. The clinical picture was multiform and depended mostly on the severity of the accompanying injuries and on the basic complications in ruptured diaphragm--incarceration and strangulation of the protruded abdominal organs. When rupture of the diaphragm is diagnosed operative treatment is as a rule mandatory. The surgical approach to left-sided ruptures of the diaphragm is the abdominal approach, because of the more frequent injury to the abdominal organs.