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LAPAROSCOPY IN THE MANAGEMENT OF DIAPHRAGMATIC RUPTURE DUE TO BLUNT TRAUMA

1998; Wiley; Volume: 68; Issue: 8 Linguagem: Inglês

10.1111/j.1445-2197.1998.tb02105.x

1440-1622

Ian Martin, N. O’Rourke, D. C. Gotley, B. Mark Smithers,

Abdominal Trauma and Injuries

Background : Traumatic diaphragmatic rupture remains diagnostic challenge often unrecognized until laparotomy in over 40% of patients and the diagnosis is delayed in further 15%. This report describes four patients diagnosed at laparoscopy with ruptured diaphragm. Methods : One patient had left diaphragmatic rupture amenable to laparoscopic repair in the emergency setting. Three patients underwent laparoscopy 2, 7 and 10 days after injury which revealed two right‐sided and one extensive left‐sided rupture, respectively; each required open repair. Results : While laparoscopy is an excellent diagnostic tool, particularly in the delayed setting, repair is not possible for right‐sided ruptures because of the liver bulk. Conclusions : Thoracoscopy in the instance of delayed presentation may offer the best chance for minimal‐access diagnosis and treatment when there is suspicion of right‐sided diaphragmatic rupture.