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 e valuates peritoneoscintigraphy in a rabbit model of TDH simulating hum an blunt injury. Ten adult New Zealand rabbits (two control, eight exp erimental) underwent tracheostomy and left thoracotomy under anesthesi a. Experimental animals received a radial phrenotomy (1.0 to 3.5 cm). Incisions were closed over thoracostomy tubes, and ventilation was dis continued. Catheters were inserted intraperitoneally, and radiotracer in saline was injected. A gamma counter was used to take sequential im ages. Transdiaphraghmatic isotope was seen in only two animals. Both h ad large injuries; in one, the catheter was directed toward the diaphr agmatic defect. We conclude that peritoneoscintigraphy is insensitive in the detection of TDH. It is unlikely to be an effective technique c oupled with diagnostic peritoneal lavage. Further efforts to refine di agnostic capability for TDH should be directed elsewhere, such as lapa roscopy.