Skip to main content
NCBI home page
Annals of Surgery logoLink to Annals of Surgery
. 1993 Dec;218(6):783–790. doi: 10.1097/00000658-199312000-00013

Traumatic diaphragmatic hernia. Occult marker of serious injury.

B F Meyers 1, C J McCabe 1
PMCID: PMC1243075  PMID: 8257229

Abstract

OBJECTIVE: Recent experience with traumatic diaphragmatic hernias at the Massachusetts General Hospital was reviewed to identify pitfalls in the diagnosis and treatment of this injury. SUMMARY BACKGROUND DATA: Traumatic diaphragmatic disruption is a common injury and a marker of severe trauma. It occurs in 5% of hospitalized automobile accident victims and 10% of victims of penetrating chest trauma. Numerous reports describe splenic rupture in 25% of patients with blunt diaphragmatic rupture, liver lacerations in 25%, pelvic fracture in 40%, and thoracic aortic tears in 5%. Diaphragmatic rupture is a predictor of serious associated injuries which, unfortunately, is itself often occult. METHODS: A chart review of all patients admitted to the Trauma Service with traumatic diaphragmatic hernias was undertaken for the period of January 1982 to June 1992. RESULTS: Data on 68 patients sustaining blunt (n = 25) and penetrating (n = 43) diaphragmatic rupture or laceration were presented. The diagnosis was made preoperatively in only 21 (31%). Associated injuries were frequent in those injured by either blunt or penetrating trauma. Sixty-six patients underwent repair, 54 (82%) through a laparotomy alone and 12 (18%) with the addition of a thoracotomy. There were five (7.4%) deaths that were caused by coagulopathy, hemorrhagic shock, multisystem organ failure, and pulmonary embolism. Complications were twice as frequent in the blunt-trauma group and included abscess, pneumonia, and the sequelae of closed head injuries. CONCLUSIONS: The recognition of diaphragmatic rupture is important because of the frequency and severity of associated injuries. The difficulties in reaching the diagnosis require an aggressive search in patients at risk.

Full text

PDF
783

Images in this article

784Figure 1.
on p.784
785Figure 2.
on p.785
785Figure 3.
on p.785
785Figure 4.
on p.785
786Figure 5.
on p.786
786Figure 6.
on p.786
786Figure 7.
on p.786

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Baker S. P., O'Neill B., Haddon W., Jr, Long W. B. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974 Mar;14(3):187–196. [PubMed] [Google Scholar]
  2. Beal S. L., McKennan M. Blunt diaphragm rupture. A morbid injury. Arch Surg. 1988 Jul;123(7):828–832. doi: 10.1001/archsurg.1988.01400310042007. [DOI] [PubMed] [Google Scholar]
  3. Beauchamp G., Khalfallah A., Girard R., Dube S., Laurendeau F., Legros G. Blunt diaphragmatic rupture. Am J Surg. 1984 Aug;148(2):292–295. doi: 10.1016/0002-9610(84)90240-x. [DOI] [PubMed] [Google Scholar]
  4. Brandt M. L., Luks F. I., Spigland N. A., DiLorenzo M., Laberge J. M., Ouimet A. Diaphragmatic injury in children. J Trauma. 1992 Mar;32(3):298–301. doi: 10.1097/00005373-199203000-00006. [DOI] [PubMed] [Google Scholar]
  5. Buckman R. F., Jr, Piano G., Dunham C. M., Soutter I., Ramzy A., Militello P. R. Major bowel and diaphragmatic injuries associated with blunt spleen or liver rupture. J Trauma. 1988 Sep;28(9):1317–1321. doi: 10.1097/00005373-198809000-00004. [DOI] [PubMed] [Google Scholar]
  6. Feliciano D. V., Cruse P. A., Mattox K. L., Bitondo C. G., Burch J. M., Noon G. P., Beall A. C., Jr Delayed diagnosis of injuries to the diaphragm after penetrating wounds. J Trauma. 1988 Aug;28(8):1135–1144. doi: 10.1097/00005373-198808000-00005. [DOI] [PubMed] [Google Scholar]
  7. Freeman T., Fischer R. P. The inadequacy of peritoneal lavage in diagnosing acute diaphragmatic rupture. J Trauma. 1976 Jul;16(7):538–542. doi: 10.1097/00005373-197607000-00004. [DOI] [PubMed] [Google Scholar]
  8. Halldorsson A., Esser M. J., Rappaport W., Valente J., Hunter G., McIntyre K. A new method of diagnosing diaphragmatic injury using intraperitoneal technetium: case report. J Trauma. 1992 Jul;33(1):140–142. doi: 10.1097/00005373-199207000-00025. [DOI] [PubMed] [Google Scholar]
  9. Johnson C. D. Blunt injuries of the diaphragm. Br J Surg. 1988 Mar;75(3):226–230. doi: 10.1002/bjs.1800750312. [DOI] [PubMed] [Google Scholar]
  10. McCune R. P., Roda C. P., Eckert C. Rupture of the diaphragm caused by blunt trauma. J Trauma. 1976 Jul;16(7):531–537. doi: 10.1097/00005373-197607000-00003. [DOI] [PubMed] [Google Scholar]
  11. Morgan A. S., Flancbaum L., Esposito T., Cox E. F. Blunt injury to the diaphragm: an analysis of 44 patients. J Trauma. 1986 Jun;26(6):565–568. doi: 10.1097/00005373-198606000-00015. [DOI] [PubMed] [Google Scholar]
  12. Rodriguez-Morales G., Rodriguez A., Shatney C. H. Acute rupture of the diaphragm in blunt trauma: analysis of 60 patients. J Trauma. 1986 May;26(5):438–444. doi: 10.1097/00005373-198605000-00005. [DOI] [PubMed] [Google Scholar]
  13. Sharma O. P. Traumatic diaphragmatic rupture: not an uncommon entity--personal experience with collective review of the 1980's. J Trauma. 1989 May;29(5):678–682. [PubMed] [Google Scholar]
  14. Shea L., Graham A. D., Fletcher J. C., Watkins G. M. Diaphragmatic injury: a method for early diagnosis. J Trauma. 1982 Jul;22(7):539–543. [PubMed] [Google Scholar]
  15. Voeller G. R., Reisser J. R., Fabian T. C., Kudsk K., Mangiante E. C. Blunt diaphragm injuries. A five-year experience. Am Surg. 1990 Jan;56(1):28–31. [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES