Traumatic rupture of the right hemidiaphragm

Six cases of traumatic rupture of the right hemidiaphragm are reviewed with emphasis on diagnostic features and operative treatment. In one (Case 6), a mass lesion was seen in the chest 2 years after the initial injury and was repaired through a right thoractomy incision. There were no deaths. Of the five cases operated on soon after the initial injury, two were approached initially via right thoracotomy incisions and both required second incisions for injuries below the diaphragm. Three ruptures of the right hemidiaphragm were successfully repaired through laparotomy incisions without extension of the incision into the chest. Laparotomy is the preferred approach for rupture of the right hemidiaphragm during the acute phase, because exposure is adequate and life-threatening injuries below the diaphragm can usually be dealt with through the same incision.