Information About Diaphragm Trauma
Diaphragmatic trauma typically results from penetrating or blunt trauma, with 80 to 90% of blunt diaphragmatic ruptures are due to car accidents. Lateral impact from a motor vehicle crash can sometimes distort the chest wall and cut the ipsilateral diaphragm. The incidence of diaphragmatic injury in blunt trauma increases in accordance with the occurrence of high-speed car accidents.
In general, most diaphragmatic injuries occur on the left side of the chest, possibly due to the presence of the liver on the right side. In a motor vehicle accident, the direction of the impact determines whether and where an injury occurs. For example, drivers more frequently experience left-sided injuries, while passengers more frequently experience right-sided injuries. A right-sided rupture is typically associated with increased severity and morbidity rates.
Blunt diaphragmatic ruptures usually result in the following associated injuries:
- Pelvic fractures in 40%
- Splenic rupture in 25%
- Liver laceration in 25%
- Thoracic aortic tear in 5-10%
Diagnosis and Treatment
While blunt trauma typically leads to larger radial tears, penetrating trauma causes smaller incisions. Typically, a standard chest radiography (x-ray) is the primary screening method for patients suffering from thoracoabdominal trauma. CT scan features for diaphragmatic ruptures are also used, and typically feature a thickening of the diaphragm, discontinuity, herniation of abdominal structures, and the collar sign (focal constriction of abdominal viscera at the site of herniation). Although MRIs permit good visualization of abnormalities, they can be difficult to rely on in an emergency.
Diaphragmatic injuries are repaired by restoring the abdomen to its original orientation (by bringing the abdominal contents back inside the abdomen) and/or creating a seal between the chest and abdominal cavity during an exploratory laparotomy. If the diaphragmatic injury is not repaired correctly, a patient is at risk of obstruction, strangulation, and other life-threatening medical conditions.
Unfortunately, diaphragmatic ruptures can be overlooked when major symptoms are associated with other injuries that sometimes accompany diaphragmatic trauma, such as heart injuries, bruising or lacerations of the lungs, pelvic fractures, and others. If this occurs and the abdominal contents drift upwards towards the chest cavity, late diaphragmatic hernia repair may be necessary. Complications can include liver abscess, pus filling the lung space, multi-system failure, gastrointestinal obstruction, pneumonia, sepsis, and related issues.
Traumatic diaphragmatic injuries can also be missed due to delayed development, making an accurate diagnosis difficult for trauma surgeons. An emergency laparotomy is standard for detecting and repairing these injuries.
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