Traumatic rupture of the diaphragm. An analysis of 121 cases.

Rupture of the diaphragm from blunt injury occurred in 4.4% of patients submitted to surgery for abdominal injury. Rupture should be suspected when there are physical signs of a crush injury to the lower chest or upper abdomen. Typical radiological signs are often obscured by a haemothorax. Passage of a nasogastric tube before radiography for blunt injury or the placing of metal markers on wounds in the 'nipples to umbilicus' area assist in diagnosis. Peritoneal lavage may be negative. Prognosis depends on associated injuries. Only 2 deaths in this series were directly related to the diaphragmatic injury.