LAPAROSCOPIC MANAGEMENT OF BLUNT DIAPHRAGMATIC INJURY

Background: Diaphragmatic injury is difficult to diagnose using curren t radiological modalities, and missed diagnosis has been associated wi th a mortality of 20-36%. Laparotomy is the most sensitive of the stan dard diagnostic tools, but its unnecessary use can be up to 25% and ca rries a morbidity of 20%. Methods: The use of the laparoscope in three cases of blunt diaphragmatic injury is reported here. Two cases were non-acute. The diagnosis of diaphragmatic injury could not be confirme d pre-operatively in any of the cases. Results: One, a left-sided inju ry, was easily diagnosed and repaired laparoscopically. The second, ri ght-sided, was confirmed laparoscopically but had to be repaired by op en due to difficulty with liver retraction. The third case, an acute i njury, was not diagnosed at laparoscopy. Findings of free brood and di stended small bowel warranted laparotomy and prevented the establishme nt of a safe, satisfactory pneumoperitoneum. Repair was performed open . None of the cases was complicated by pneumothorax. Conclusions: Lapa roscopy is a useful tool for diagnosis of non-acute blunt diaphragmati c injury but has limitations in the acute setting. Left-sided injuries can be repaired laparoscopically but right-sided injuries proved diff icult and may be better dealt with thoracoscopically.