Traumatic rupture of the diaphragm

Diaphragmatic rupture following trauma is often an associated and missed in jury. The diagnosis is difficult, so is usually made intraoperatively. Twen ty-one patients with traumatic rupture of the diaphragm (TRD) who presented between 1995 and 1998 were retrospectively analysed: 12 had penetrating in juries and nine had blunt injuries. Right-sided defects exceeded left (12 v s 9). Only seven patients had signs and symptoms directly referrable to rup ture of the diaphragm. All patients were operated on through a midline lapa rotomy. Diaphragmatic hernia was seen in six patients (28.5%); 20 (95%) pat ients had concomitant injuries. The liver was the most commonly injured org an (10 patients). The aim of this study was to report our experiences with TRD and review the literature. We conclude that correct preoperative diagno sis of TRD needs a high index of suspicion. It can be diagnosed intraoperat ively by explorative laparotomy. Most ruptures can be repaired by the abdom inal approach.