Blunt traumatic rupture of the diaphragm: Study of 33 cases

Objective: to assess the role of clinical manifestations and radiological findings in the early recognition and diagnosis of blunt diaphragmatic rupture, with determination of the operative findings during surgical intervention. Design: a prospective case series study. Setting: Al-Jamhori Teaching Hospital in Mosul, during the period July 1999-June 2004. Participants: thirty three (33) patients with blunt traumatic rupture of the diaphragm proved by surgery. Results: three quarters of the blunt diaphragmatic rupture were caused by motor vehicle accidents, 91% of the patients had respiratory embarrassment. Only 27.2% of the patients were diagnosed by chest x-ray, the remaining 72.8% were discovered during laparotomy. The left dome of the diaphragm was ruptured in 75.8%, whereas herniation of the abdominal viscera into the chest was found in 45.8%. Concomitant intra-abdominal injury was found in 84.8% of the patients. The mortality is sharply increased when the right dome of the diaphragm is ruptured.Conclusion: the clinical features may be masked by other chest or abdominal injuries. Chest-x ray is a reliable test to diagnose diaphragmatic rupture. The left hemi-diaphragm is more commonly injured; in addition concomitant intra- abdominal injuries are very common. A meticulous inspection of the diaphragm should be undertaken during all exploratory laparotomies for trauma.