Thoracoscopic repair of missed diaphragmatic injury in penetrating trauma: case report.

We report two cases of missed diaphragmatic injury which were diagnosed and repaired using a thoracoscopic approach. A right diaphragmatic injury sustained via a stab wound to the chest was diagnosed and repaired thoracoscopically using a stapling technique. A second patient sustained an injury to the right diaphragm from a gunshot wound, which was sutured thoracoscopically. Both patients recovered uneventfully and had shortened hospital stays in spite of the nature of their injury and initial delay in diagnosis. With the increase in unsuspected diaphragmatic injuries being reported, we feel that combined thoracoscopy and laparoscopy may offer a therapeutic as well as diagnostic benefit in selected stable patients with penetrating injuries to the upper abdomen and lower chest. Although this initial report is encouraging, further investigation is needed to determine optimal patient selection criteria as well as the cost-effectiveness of this approach.