ACUTE DIAPHRAGMATIC RUPTURE AFTER BLUNT TRAUMA

In a retrospective analysis of 20 patients operated on for acute diaph ragmatic rupture following blunt trauma, 85 % of the patients presente d with shortness of breath, and 85 % had signs of peritoneal irritatio n or abdominal distension on physical examination. Preoperatively, a d iaphragmatic rupture was diagnosed or suspected in 80 %, and was based on chest X-ray examination alone or in combination with other radiolo gical studies in all but one case. The diaphragmatic rupture was left- sided in 70 % right-sided in 20 % and bilateral in two cases. Intratho racic herniation of abdominal organs occurred in 85 % of the patients causing a strangulation of the stomach in one case. Three patients (15 %) died from associated injuries, and all survivors had postoperative complications most commonly pulmonary. It is concluded that blunt tra uma patients having respiratory distress and abdominal tenderness on a dmission should undergo a chest X-ray examination for suspected diaphr agmatic rupture. Due to the high risk of organ herniation which can le ad to strangulation, early diagnosis and operative management are impo rtant, and should not be overlooked in cases with associated injuries amenable to nonoperative management. Although the outcome is determine d by the severity of associated injuries, prolonged postoperative vent ilatory support may be required in about half of the patients.