Traumatic rupture of the right diaphragm
The diagnosis and management of diaphragmatic injuries still presents a problem. In a recently published series the proportion of these injuries which is initially overlooked remains at between 20 and 40%, and the post-operative mortality at 21%. Based on two personal cases of rupture of the right diaphragm and on an analysis of published series, we endeavour to lay down some guidelines for the diagnosis and treatment of this injury. Appropriate radiological investigations include chest x-ray (which should be repeated), abdominal ultrasound and thoraco-abdominal tomodensitometry. The treatment is surgical. The preferred route of access in the elective case is via the thorax, but in emergency, in the absence of a pre-operative diagnosis, an abdominal route may be indicated.
Key wordsRupture of the right diaphragm Closed trauma Surgery Thoracoscopy
Unable to display preview. Download preview PDF.
- Azorin J, Lamour A, Hoang Ph TD, Destable MD, de Saint Florent G (1987) Traumatismes graves du thorax. Encycl Med Chir, Urgences, 24117 DioGoogle Scholar
- Fourquier P, Mouroux J, Riquet M (1997) Rupture diaphragmatique: étude multicentrique. Diagnostic et traitement. J Chir Thorac Cardio-Vasc 1–2: 47–52Google Scholar
- Mansour KA (1997) Trauma to the diaphragm. Trauma of the chest. Chest Surg Clin North Am 2: 373–383Google Scholar
- Meyer DM, Jessen ME, Wait MA, Estrera AS (1997) Early evacuation of traumatic retained hemothoraces using thoracoscopy: a prospective, randomized trial. Ann Torac Surg 64: 1396–1401Google Scholar
- Ochsner MG, Rozycki GS, Lucente F, Wherry DC, Champion H.R (1993) Prospective evaluation of thoracoscopy for diagnosing diaphragmatic injury in thoraco abdominal trauma: a preliminary report. Trauma 34: 704–710Google Scholar