Acute traumatic diaphragmatic ruptures:: Case report

The study comprises 5 cases with diaphragmatic injury, which were caused by blunt thoracoabdominal trauma between January 2002 and January 2005. All patients were male and the mean age was 36.4 years. Diaphragmatic rupture was detected in 5 (1%) out of 496 patients. All patients had left diaphragmatic injuries; one was intervened with transabdominal (20%) and 4 with transthoracic approach, and all the ruptures were succesfully repaired with primary sutures. The chest x-ray, especially when performed after insertion of a nasogastric tube, was a useful screening tool. Gastric herniation was the most common herniation. The overall perioperative mortality was 20% with one fatal case and the remaining patients were discharged uneventfully. In the left hemidiaphragm ruptures, the transabdominal approach should be performed due to the high frequency of the coinciding intraabdominal injuries. However, in patients without intraabdominal injury, transthoracic approach may be the best procedure to be performed.