Peritoneoscintigraphy in the diagnosis of traumatic diaphragmatic rupture

Current diagnostic modalities for traumatic diaphragmatic hernia (TDH) have limitations. Prior models differ from human injury. This study evaluates peritoneoscintigraphy in a rabbit model of TDH simulating human blunt injury. Ten adult New Zealand rabbits (two control, eight experimental) underwent tracheostomy and left thoracotomy under anesthesia. Experimental animals received a radial phrenotomy (1.0 to 3.5 cm). Incisions were closed over thoracostomy tubes, and ventilation was discontinued. Catheters were inserted intraperitoneally, and radiotracer in saline was injected. A gamma counter was used to take sequential images. Transdiaphraghmatic isotope was seen in only two animals. Both had large injuries; in one, the catheter was directed toward the diaphragmatic defect. We conclude that peritoneoscintigraphy is insensitive in the detection of TDH. It is unlikely to be an effective technique coupled with diagnostic peritoneal lavage. Further efforts to refine diagnostic capability for TDH should be directed elsewhere, such as laparoscopy.