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Abstract
In the examination of patients with severe thoracic and/or abdominal trauma not requiring
surgical exploration, special attention should be given to signs of traumatic diaphragmatic
herniation (TDH). We analysed the hospital records of 63 patients with traumatic injuries
of the diaphragm. Of these patients, 39 had suffered a blunt trauma in a traffic accident,
21 penetrating trauma, and three had fallen from a great height. There were 51 patients
(81 per cent) with left-sided diaphragmatic injuries, ten (16 per cent) with right-sided
injuries, and in two patients (3 per cent) the injuries to the diaphragm were bilateral.
There were 22 patients (35 per cent) who had intrathoracic migration of abdominal
viscera. Surgical treatment was given in all cases. Twelve patients (19 per cent)
died due to massive haemorrhage, neurological lesions, or septicaemia. Based on the
literature and our own experience, we developed a diagnostic protocol for the management
of diaphragmatic injuries. Chest radiographs should be made routinely. If diaphragmatic
injury is suspected, ultrasound investigation must be performed. If the physician
is still in doubt, computed tomography should be performed. At laparotomy, the diaphragm
should always be thoroughly examined for lacerations.
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Article info
Publication history
Accepted:
November 16,
1990
Identification
Copyright
© 1991 Published by Elsevier Inc.
