[Traumatic rupture of the diaphragm: diagnostic considerations, prognostic factors, outcomes].

Unlabelled: Diaphragmatic rupture remains a diagnostic challenge because of the lack of an accurate test demonstrating the injury.

Aim: To analyze our experience with the management of these injuries, diagnosis problems, and to identify predictors of outcomes.

Material And Method: Sixty-one patients were treated for diaphragmatic rupture in our hospital, between January 1992 and August 2003.

Results: Blunt trauma accounted for 15 injuries (24.6%) and penetrating trauma for the rest of 46 injuries (75.4%). The preoperative diagnostic was established for 17 patients (27.8%), 7 blunt and 10 penetrating. Twenty-nine patients (47.5%) presented with hemorrhagic shock upon admission and 48 patients (78.6%) had associated injury with an average Injury Severity Score of 24 (range 6-75). All cases but 4 were operated on the first 12 hours upon admission. Two right penetrating lesions were treated conservatively and two cases presented after 11 and 23 years respectively from the trauma episode. Intraoperatively, 15 right lesions (24.6%), 45 left (73.7%) and one bilateral (1.6%) were identified. There were 9 deaths (14.7%) and 14 patients (22.9%) developed complications.

Conclusions: Hemorrhagic shock upon admission, Injury Severity Score, mechanism of the injury and age strongly influenced the outcome (p < 0.05). In emergency trauma settings the diagnostic for diaphragmatic lesions is mainly established by laparotomy. A high index of suspicion and a thorough examination of both diaphragms during laparotomy is mandatory in order to avoid missing traumatic diaphragmatic injuries.