Penetrating Right Thoracoabdominal Injuries: Do You Need to Repair the Diaphragm?

Patients with penetrating right thoracoabdominal injuries are often managed nonoperatively. However, it is unclear whether routine surgical repair of the diaphragm is warranted. This was a single-center retrospective review of all patients presenting to our level 1 trauma center with a penetrating right thoracoabdominal injury between 2013 and 2023. A total of 37 patients met inclusion criteria for this study. Of this group, 64.9% (24/37) underwent diaphragm repair. Demographic data including age, initial vital signs, and Injury Severity Score (ISS) were similar. When considering bile-related complications, there were no differences in the rates of bilothoraces (1/24, 4.2% vs 1/13, 7.7%, P = .7) or biliopleural fistulas (1/24, 4.2% vs 1/13, 7.7%, P = .7) between groups. Nonoperative management of penetrating right thoracoabdominal injuries was not associated with a higher rate of bile-related complications or delayed thoracic surgery suggesting that diaphragm repair in patients with concomitant liver injuries may not be necessary.