Diagnosis and Surgical Treatment of Diaphragmatic Rupture Following Blunt Abdominal Traumas

Diaphragmatic rupture observed in trauma patients with multiple organ injuries is a rare but serious problem. The incidence rate for diaphragmatic rupture is 0.8-5% while mortality rate is between 16.6-33.3%. There are cases in the literature which diaphragmatic rupture was diagnosed years after the trauma. Symptoms related to heart or lung compression due to early or delayed displacement of the abdominal viscera into the thorax or strangulation of abdominal viscera lead the physician to diagnosis. A 75-year old female patient who presented to the emergency room with shortness of breath, abdominal pain, nausea and vomiting complaints had been in a traffic accident 20 days earlier and admitted to the hospital. Abdominal ultrasound, plain radiographs and laboratory tests after the accident had been normal and the patient was discharged after a 24 h follow-up. Patient had signs of intestinal obstruction and abnormal blood gas values and posterior-anterior chest radiograph revealed elevation of the left hemidiaphragm. Thoracic computarized tomography demonstrated elevation of the posterolateral region of the left hemidiaphragm and displacement of the subdiaphragmatic organs within the thorax, up to the level of the carina. The patient had laparotomy under emergency conditions when rupture of the diaphragm was identified and repaired transabdominally. Diaphragmatic ruptures secondary to blunt traumas can be diagnosed with its early or late symptoms. Non-specific symptoms like chest pain, dyspnea, tachypnea, shortness of breath observed in patients should raise suspicion. Early or late deterioration in blood gas analyses following blunt traumas should be assessed carefully. Diagnosis can be rapidly established with direct radiographs, thoracic computarized tomography and magnetic resonance imaging. Treatment of rupture is surgery. Generally the diaphragm is repaired by the transabdominal approach while complicated ruptures can be assessed with a lower thoracic incision. Being extra vigilant following serious blunt traumas is an important factor in establishing the diagnosis.