Diaphragmatic Trauma

Abstract

The diaphragmatic lesion leads to equalization of the pleural and peritoneal compartment pressures, causing a migratory tendency of the viscera inside thorax through the lesion. This fact may lead to a similar case of hypertensive pneumothorax, with potentially fatal cardiorespiratory repercussions, and cause pleural contamination by gastrointestinal contents. The most common acute complications of traumatic diaphragmatic lesions are dehiscence of the suture, diaphragmatic folding resulting from traumatic or iatrogenic injury of the phrenic nerve, cardiorespiratory failure, hemorrhage, empyema, or subphrenic abscess. However, strangulated hernias with or without perforation of abdominal viscera and intestinal obstructions may occur as late complications. Patients with late diaphragmatic hernia have a 25% mortality rate, related to the septic condition due to incarceration, ischemia, and necrosis, with potential for subsequent rupture, of the herniated abdominal viscera to the pleural space.