Diagnosis and treatment of blunt diaphragmatic rupture:an analysis of 36 cases

Objective: To study the clinical diagnosis and surgical intervention of blunt traumatic diaphragmatic rupture.Methods: The clinical data of 36 patients with traumatic diaphragmatic rupture from January 2000 to December 2008 were retrospectively reviewed,including etiology,traumatic position,complicated injury,score of injury severity,diagnosis course and surgical treatment.In the series,there were 29 cases of left-diaphragmatic rupture,6 right diaphragmatic rupture and 1 case in bilateral.All the patients received operation.Thoracotomy was performed in 6 patients,laparotomy in 30,thoracotomy plus laparotomy in 2 and combined thoraco-laparotomy in 1 case.Results: Thirty-four cases were cured.One patient died of liver rupture,hemorrhagic shock,wound shock and DIC,and one of severe cerebral injury and MODS.Conclusion: Diaphragmatic rupture caused by blunt injury could lead to severe thoracoabdominal injury.In spite of high mortality rate,the condition is usually under diagnosed.Early diagnosis and active operation including definite treatment of complicated injures are the keys to increase survival rate and reduce mortality.