[Postraumatic rupture of diaphragm with projection of the liver into the right pleural cavity--the case description].

The proper initial diagnosis of acute diaphragm rupture in patients with multiple blunt trauma can be found difficult. It is the result of non specific clinical picture and dominating signs of injuries of other organs. Delayed diagnosis has a serious impact on worse conditions of diaphragm reconstruction and prognosis. A 53-year-old woman, with a severe abdomen injury after a car accident, is reported with perforation of the alimentary tract in two places (the small bowel and the sigmoid) and respiratory insufficiency caused by the projection of the liver into the thoracic cavity due to a large rupture of the right hemidiaphragm. The patient was initialy treated in another hospital in the intensive care ward where she was operated on three times by laparotomy acces owing to the perforations of the small and large bowels and the following complications. Eventually, she was admitted to our hospital one month after the accident so as to be treated for respiratory insufficiency. We described the difficulties in the treatment of this case in the late period after the injury. Finally the woman was treated with moderate success. Diaphragm laceration was repaired by the right thoracotomy access. In the next stage we performed the reconstruction of the alimentary tract and eliminated iloeostomy and colostomy during the fourth in turn laparotomy. Afterwards the patient in the state of the relative respiratory sufficiency was sent to the original hospital for further treatment.