Triple diaphragmatic rupture with disruption of the pericardium: pericardial reconstruction by lyophilized dura allograft.

A patient is described with the unusual findings of intrapericardial diaphragmatic rupture combined with total disruption of the pericardium and partial abruption of the diaphragm from its costal origin. Through a third traumatic diaphragmal leak, the small intestine had prolapsed intercostally without contact to the pleural space. Surgical repair was done by direct diaphragmatic suturing and lyophilized dura allograft reconstruction of the left pericardial circumference. Postoperatively, atrioventricular block secondary to myocardial contusion necessitated pacemaker implantation. The patient left the hospital five weeks after the injury.