Fiber-endoscopic thoracoscopy for diaphragmatic injury in children.

Diagnosis of a diaphragmatic injury is important to prevent late sequelae of herniation of abdominal viscera and intestinal gangrene. A safe, simple, reliable and inexpensive method of assessing the diaphragm was devised for use in the emergency department. A standard fiberoptic upper gastrointestinal endoscope was used as a thoracoscope to visualize the diaphragm, using the thoracostomy tube incision as the portal of entry to the thoracic cavity. Two cases in which this technique was used are presented. The procedure was well tolerated and allowed for an adequate view of the diaphragm and prompt decision making.