DIAGNOSIS AND THERAPY OF DIAPHRAGMATIC RU PTURE IN BLUNT THORACIC ANDABDOMINAL-TRAUMA

Summ.: Diagnosis of diaphragmatic rupture is often missed after blunt thoracic and abdominal injuries because diaphragmatic injury does not play an important role beside severe injuries of intrabdominal and/or thoracic organs. Between 1976 and 1993, 141 patients were treated for traumatic injury of the diaphragm. In 42 patients with penetrating inj uries following stab or shot wounds diaphragmatic lesions were diagnos ed by the emergent surgical therapy. 99 had diaphragmatic tears from b lunt thoracic or abdominal trauma by accidents. 14 of 99 patients sust ained isolated diaphragmatic rupture, in 85 the rupture was combined w ith other injuries, 24 had fractures of the pelvic ring. Preoperativel y the following diagnostic procedures were performed: chest radiograph in 99 patients, abdomen radiograph in 75, contrast radiographs in 34, angiography in 9, sonography in 74 and computed tomography in 48. Sen sitivity and specificity of these diagnostic methods depend on the dim ension of intrathoracic prolaps of abdominal organs. The sensitivity o f contrast radiographs ranged from 72-78%. With the additional experie nce of ultrasonography since 1985 the sensitivity came up to 82%. In 1 1 patients additional diaphragmatic rupture was diagnosed by laparotom y indicated by liver and/or splenic rupture. Therapy of diaphragmatic injury was performed in 83 patients within 4 days, in 9 within 4 month s and in 7 later than one year. For diaphragmatic repair 87 patients u nderwent laparotomy and 12 thoracotomy. Local complications were found in 13 patients (13.1%). 19 patients (19.2%) died postoperatively due to accompanying injuries.