Diaphragm

Blunt traumatic diaphragmatic rupture is due to an increase in intrathoracic or intra-abdominal pressure. Usually, the left hemidiaphragm is involved. The diagnosis of a right-sided or bilateral rupture is relatively rare, although reported figures are increasing (right-sided in 20 per cent and bilateral in 6 per cent of patients). A right-sided tear is seen more frequently in victims on the passenger side of the car, implying a vector-related mechanism. The tear is usually located at the posterolateral side. A left-sided tear can lead to visceral herniation and strangulation of stomach, bowel, or spleen. However, strangulation is a rare phenomenon, and morbidity and mortality are related to other injuries. There is no difference in postoperative course between left- and right-sided tears. Penetrating trauma leads to small diaphragmatic holes, which are repaired during laparotomy.

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