LAPAROSCOPY IN THE MANAGEMENT OF DIAPHRAGMATIC RUPTURE DUE TO BLUNT TRAUMA

Background: Traumatic diaphragmatic rupture remains a diagnostic chall enge often unrecognized until laparotomy in over 40% of patients and t he diagnosis is delayed in a further 15%. This report describes four p atients diagnosed at laparoscopy with a ruptured diaphragm. Methods: O ne patient had a left diaphragmatic rupture amenable to laparoscopic r epair in the emergency setting. Three patients underwent laparoscopy 2 , 7 and 10 days after injury which revealed two right-sided and one ex tensive left-sided rupture, respectively; each required open repair. R esults: While laparoscopy is an excellent diagnostic tool, particularl y in the delayed setting, repair is not possible for right-sided ruptu res because of the liver bulk. Conclusions: Thoracoscopy in the instan ce of delayed presentation may offer the best chance for minimal-acces s diagnosis and treatment when there is suspicion of a right-sided dia phragmatic rupture.