Diaphragmatic Injuries



Background

  • Diaphragm rises to 4th intercostal space in forced expiration!
  • Poor signs - 2/3 have other injuries
  • 1/3 of diaphragmatic injuries have herniated organs at surgery
  • Children herniate more readily
  • 30% mortality if bowel incarcerated
  • Never spontaneously repairs

Investigations

  • CXR may be normal in 67%
  • Barium - whole bowel must be seen
  • Ultrasound poor visibility
  • CT Poor visibility
  • Thoracoscopic poor visibility
  • DPL fluid in thoracostomy tube diagnostic!
  • Laparoscopy - good visual but risk Pneumothorax /pneumoperitoneum
  • 85% represent 3 years (delayed treatment worse prognosis)
RupturedDiaphragm01
RupturedDiaphragm04

Management

  • Management = Drain, PPV, Surgery

Contents by Dr Fergal Cummins, Dr Íomhar O' Sullivan 02/06/2004. Reviewed by Dr ÍOS 20/05/2005, 10/06/2006, 16/01/2007. Last review Dr ÍOS 21/06/21.