Abstract
Diaphragm injuries are infrequent but can lead to severe short- and long-term complications if not identified and repaired. They are more common in penetrating trauma but tend to be more severe in the setting of blunt trauma. Diaphragm injuries are rarely isolated and often associated with other, immediately life-threatening conditions such as hepatic, splenic, and pulmonary lacerations.
While diagnostic imaging studies may demonstrate nonspecific findings suggestive of diaphragm injuries (e.g., hemothorax, diaphragm elevation), they cannot reliably identify them. Therefore, laparoscopy remains the best modality to detect and repair diaphragm lacerations in patients who are at risk for this injury but do not require operative exploration for other reasons.
The American Association for the Surgery of Trauma (AAST) organ injury grading system allows for the classification of diaphragm injuries and selection of repair method. Most small-sized and moderately sized lacerations (AAST grade I–III) can be closed primarily with a heavy, (non-)absorbable running suture. Higher grades with substantial loss of diaphragmatic muscle or its lateral attachments (AAST grade IV and V) may require complex repair strategies including mesh repair and flaps.
An important short-term complication of a missed small to moderate diaphragm injury is empyema due to spillage of intestinal content, bile, or blood into the thoracic cavity. Long-term, herniation of abdominal contents into the chest can occur weeks to years after the original injury and may lead to life-threatening strangulation of stomach and bowel.
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Leichtle, S.W., Aboutanos, M.B. (2021). Diaphragm. In: Galante, J.M., Coimbra, R. (eds) Thoracic Surgery for the Acute Care Surgeon. Hot Topics in Acute Care Surgery and Trauma. Springer, Cham. https://doi.org/10.1007/978-3-030-48493-4_18
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