Rupture of the diaphragm caused by blunt trauma. Review of 54 successive cases.

From 1970 to 1987, 54 patients were treated for rupture of the diaphragm as a result of blunt trauma, mostly due to road accidents. In more than 75% of the cases, other severe post-traumatic lesions were noted in association with the rupture. There were 46 lesions in the left hemidiaphragm. An early diagnosis was made 34 times (i.e., within 24 h after the accident). This is why it is so important to interpret plain X-ray films of the thorax and abdomen correctly, perhaps after inserting a nasogastric tube. In general, exploration by laparotomy is preferred. Thoracolaparotomy is only used in cases of thoracic or thoracoabdominal injuries associated with important lesions in the lungs or mediastinal organs or in the case of longstanding ruptures accompanied by herniation of different organs. The total mortality was 20%. Death was due to hypovolemia, serious brain injuries, or multiple organ failure (MOF) due to sepsis.