Traumatic rupture of the diaphragm.

The experience gained during a 16 year period from 27 patients with traumatic rupture of the diaphragm is reported upon. Automobile accidents were the most frequent cause of diaphragmatic rupture, and the left hemidiaphragm was that most often affected. The diagnosis is most frequently missed during the initial examination and treatment of such patients. The diagnosis was missed in the present material in 48 per cent of the patients during the first 24 hours. The preoperative diagnosis is based upon the suspicion that all patients with traumatic injuries to the thoracoabdominal region may have a rupture of the diaphragm. An ordinary roentgenogram of the chest gives rise to the diagnosis in 17 patients. Other diagnostic possibilities are nasogastric intubation and the demonstration of the passage of air or contrast medium from the abdominal cavity to the pleural cavity. Special attention should be paid to patients receiving artificial ventilation, in whom the positive airway pressure may keep the viscera in their correct position. Nine patients died during hospitalization of associated injuries, and no deaths were the direct result of the ruptured diaphragm. Follow-up time of one to 16 years, a mean of 5.1 years, showed that 15 patients had no pulmonary complaints, while three complained of minor respiratory or abdominal discomfort.