Rupture of the diaphragm is an unusual injury following blunt abdominal
trauma. Due to its rather discrete initial symptoms, the diaphragmatic
rupture is frequently overlooked in the acute stage. Of 11 patients operated on, only four
ruptures were detected in association with the accident. The clinical picture was dominated by the patient's other
injuries. Symptoms referable to the diaphragmatic
rupture were
pain in the upper abdomen and dyspnoea, especially in the recumbent position. The diagnosis was usually established by serial chest roentgenography, in a few cases supplemented by
barium contrast studies, angiography or air insufflation in the abdomen (
pneumoperitoneum). In the initial phase, an elevated and paradoxically moving diaphragm was usually seen on the injured side. Later, hermiation of viscera into the chest ensued, causeing respiratory impairment and, in about half of the cases, also gastro-intestinal disturbances. Early operation is advised in all cases of diaphragmatic
rupture. Late complications are then avoided and the repair is technically easier to perform. In the presence of associated intra-
abdominal injuries, e.g.
rupture of the spleen, an abdominal incision is preferred. In isolated diaphragmatic
ruptures, particularly in the late phase, the operation is more easily carried out through a low
thoracotomy. The diaphragmatic
rupture should be repaired with interrupted non-absorbable
sutures--otherwise a risk of recurrence exists.