Diaphragmatic injuries in childhood

The early detection and surgical repair of diaphragmatic injury is vital fo r saving the life of symptomatic children suffering from trauma. Furthermor e, an accurate diagnosis may be difficult, particularly in right-sided diap hragmatic injuries. Fifteen children with diaphragmatic injury treated at o ur depart ment between 1977 and 1998 were evaluated retrospectively. They i ncluded 9 boys and 6 girls, and consisted of 8 left- and 6 right-sided inju ries, and 1 midline retrosternal injury, due to a blunt (n = 13) or penetra ting (n = 2) trauma. The most frequent symptoms were dyspnea (86.6%), and a bdominal pain and vomiting (13.4%). The diagnosis was confirmed preoperativ ely in 13 patients based on chest X-ray (n = 7), gastrointestinal series (n = 3), barium enema (n = 1), and computed tomography and/or ultrasonography findings (n = 2). Among these, a diagnostic delay occurred in 3 patients w ith right-sided injuries. A primary repair was performed through a laparoto my (n = 14) or thoracotomy (n = 1). Postoperative intussusception was the m ost: frequent complication (II = 2). Diaphragmatic injury must be considere d in any child who has sustained a thoracoabdominal trauma. Serial chest: X -rays should be taken especially in right-sided injuries in which a conside rable diagnostic delay may occur. Further radiological methods may be neces sary to confirm the diagnosis. In addition, postoperative intussusception m ay be encountered following diaphragmatic repair.