Skip to main content

Surgical management of diaphragmatic injuries



Traumatic diaphragmatic lesions have variable presentations and need a high index of suspicion to be diagnosed in the acute phase. Delayed diagnosis is frequently associated with considerable comorbidity.

Material and Methods

The present retrospective study aims to evaluate the radiological findings and discuss the surgical approach for the repair of the injured diaphragm. This study includes fifteen cases with diaphragmatic injuries, which were surgically managed between 1994 and 2005. Injuries resulted from violent blunt trauma in twelve patients and three patients had penetrating injuries. Patients presented with hypotension, respiratory insufficiency, acute abdomen and hemothorax. Preoperative diagnosis was established in 12/15 (80%) patients depending on the clinical and the chest skiagram findings. Intra-operative diagnosis was made in the rest. Injuries were more common on the left side (11/15, 73.33%). All these patients underwent repair of the defect by direct closure in double layer using monofilament polypropylene suture. In addition, laparotomy was performed in four patients who had liver and spleen injury. Concomitant procedures included lobectomy, segmentectomy, repair of lung laceration, spleenectomy, spleenorraphy, repair of gastric perforation, intestinal perforation and mesenteric tear.


One patient died (1/15, 6.66%) of associated injuries. Two patients with major liver injuries had prolonged drainage and repeated subdiaphragmatic collections.


Associated lesions particularly influence the outcome after traumatic lesions of the diaphragm. Surgical exploration is mandatory whenever diaphragmatic injuries are suspected. Right-sided injuries are best exposed and managed through the right thoracotomy. Direct suture is effective in preventing future specific complications.

This is a preview of subscription content, access via your institution.


  1. Grage TB, Maclean LD, Cambella GS. Traumatic rupture of diaphragm. A report of 26 cases. Surgery 1959; 46: 669–681.

    PubMed  CAS  Google Scholar 

  2. Rossetti G, Brusciano L, Maffettone V, et al. Giant right posttraumatic diaphragmatic hernia: laparoscopic repair without a mesh. Chir Ital 2005; 57(2): 243–246

    PubMed  Google Scholar 

  3. Yang GP, Tang CN, Siu WT, Ha JP, Tai YP, Li MK. Diaphragmatic hernia: an uncommon cause of dyspepsia. JSLS 2005; 9: 352–355.

    PubMed  Google Scholar 

  4. Childress ME, Grimes OF. Immediate and remote sequelae in traumatic diaphragmatic hernia. Surg Gynaecol Obstet 1961; 113: 573–584.

    CAS  Google Scholar 

  5. Stagnitti F, Priore F, Corona F, et al. Traumatic lesions of the diaphragm. G Chir 2004; 25(8–9): 276–282.

    PubMed  CAS  Google Scholar 

  6. Tiberio GA, Portolani N, Coniglio A, Baiocchi GL, Vettoretto N, Giulini SM. Traumatic lesions of the diaphragm. Our experience in 33 cases and review of the literature. Acta Chir Belg 2005; 105: 82–88.

    PubMed  CAS  Google Scholar 

  7. Blaivas M, Brannam L, Hawkins M, Lyon M, Sriram K. Bedside emergency ultrasonographic diagnosis of diaphragmatic rupture in blunt abdominal trauma. Am J Emerg Med 2004; 22: 601–604.

    PubMed  Article  Google Scholar 

  8. Nchimi A, Szapiro D, Ghaye B, et al. Helical CT of blunt diaphragmatic rupture. AJR Am J Roentgenol. 2005; 184: 24–30.

    PubMed  Google Scholar 

  9. Iwasaki M, Inoue H. Traumatic injuries of the diaphragm. Kyobu Geka 2004; 57(8): 795–799.

    PubMed  Google Scholar 

  10. Divisi D, Battaglia C, De Berardis B, et al. Video-assisted thoracoscopy in thoracic injury: early or delayed indication? Acta Biomed Ateneo Parmense. 2004; 75: 158–163.

    Google Scholar 

  11. Mahajna A, Mitkal S, Bahuth H, Krausz MM. Diagnostic laparoscopy for penetrating injuries in the thoracoabdominal region. Surg Endosc 2004; 18: 1485–487.

    PubMed  Article  CAS  Google Scholar 

  12. Wright BE, Reinke T, Aye RW. Chronic traumatic diaphragmatic hernia with pericardial rupture and associated gastroesophageal reflux. Hernia 2005; 9: 392–396.

    PubMed  Article  CAS  Google Scholar 

  13. Tsuda M, Ichiki K, Doki Y, Yamashita S, Misaki T, Sugiyama S. Thoracic surgical approach for traumatic diaphragmatic hernia. Kyobu Geka 2004; 57: 949–952.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Abha Chandra.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Chandra, A., Samantaray, A., Balasubramani, G. et al. Surgical management of diaphragmatic injuries. Indian J Thorac Cardiovasc Surg 23, 202–207 (2007).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:

Key words

  • Diaphragmatic hernia
  • Traumatic
  • Lobectomy