RUPTURE OF THE DIAPHRAGM AFTER BLUNT TRAUMA

Objective: To analyse our cases of acute rupture of the diaphragm afte r blunt trauma to find out how to diagnose It earlier and manage it mo re promptly in future. Design: Retrospective study of casenotes. Setti ng: Division of general surgery, district hospital, Taiwan. Patients: 50 Patients who presented with acute rupture of the diaphragm after bl unt trauma during the 10 year period 1982-91. Main outcome measures: M orbidity and mortality. Results: The left hemidiaphragm was injured in 43 cases (86%), and the right in 7 (14%). The most common cause was r oad traffic accidents. 48 Patients had associated injuries, mainly to the chest and abdomen, and pelvic fractures. 44 Ruptured diaphragms we re diagnosed before operation by chest radiography or upper gastrointe stinal contrast examination. The transabdominal approach was the most appropriate, because 23 patients had intra-abdominal visceral injuries as well. 20 Patients (40%) had complications, and the rate was 33% am ong those treated within 24 hours and 70% among those whose treatment was delayed longer than 24 hours (p = 0.067). There were 3 deaths (6%) ; one patient died of empyema of the right chest as a result of simult aneous perforation of a hollow viscus. 6 Patients were permanently dis abled by head and spinal injuries, and pelvic fractures. Conclusion: T he prognosis of repairing diaphragmatic hernias is good as the disabil ity rate is low. The diagnosis should be kept in mind in all patients with chest injuries, pelvic fractures, or abdominal injuries with hypo xaemia, as this will result in earlier treatment and improve prognosis . The transabdominal approach is the most appropriate because it makes simultaneous abdominal injuries easier to treat. Correct operative ma nagement at an early stage will keep mortality to a minimum.