Traumatic rupture of the diaphragm.

This paper reviews 58 patients with traumatic rupture of the diaphragm treated at the Royal Adelaide Hospital during an 11-year period. The series appears to be the largest reported from one centre. The majority of cases resulted from blunt trauma to the trunk caused by motor vehicle accidents. More than half these patients sustained multiple injuries. A smaller group of patients had penetrating injuries to the diaphragm from gunshot or stab wounds. Clinical diagnosis of the ruptured diaphragm was seldom possible; an erect X-ray film of the chest was the best clue to diagnosis. In the acute phase, the injury was approached through laparotomy because of the need to exclude or treat other intra-abdominal injuries. Where diagnosis or treatment were delayed, thoracotomy was the approach of choice. Careful postoperative management, particularly of associated chest injuries, was the key to the low mortality achieved in this series.