[Reflections on recent ruptures of the diaphragm. Apropos of 45 cases]

Trauma-induced ruptures of the diaphragm are very exceptional but are regularly encountered in trauma surgery units. Closed ruptures occur in 60 to 80% of diaphragm lesions in European series, 9 times out of 10 after traffic accidents. Large American trauma centers however, have had more experience with stab of firearm wounds. The diagnosis raises many problems and requires further exploration after the standard chest x-ray. We discuss the different explorations which can be contributive in both emergency and non-emergency situations. The most appropriate therapeutic approach is also discussed. Should thoracotomy or laparotomy be used? What precautions are required prior to surgery? Can laparoscopy be useful?