Diaphragm injury

Background

  • Associated with penetrating or blunt trauma to lower chest/upper abdomen
  • If missed, can lead to herniation of viscera and tension enterothorax
  • Most commonly left sided
  • Majority will have other injuries which can mask symptoms of diaphragm injury
  • 75% of the time occurs on the left side; the liver is protective on the right side
  • Presentation can be delayed months to years after the initial trauma

Clinical Features

Differential Diagnosis

Thoracic Trauma

Evaluation

  • CXR may show visceral herniation
    • Poorly sensitive
  • CT chest/abdomen/pelvis with contrast may better detect smaller herniations (roughly 82% sensitive and 88% specific) [1]
    • "Collar sign"
      • waist-like constriction of abdominal viscera
  • MRI better evaluates the diaphragm itself in stable patients in whom the diagnosis is unclear
  • Surgical exploration is ultimately the best diagnostic modality (thoracoscopy vs laparoscopy vs ex-lap depending on concurrent injuries)
  • Thoracoscopy
  • Laparoscopy

Management

  • NGT decompression
  • Surgery is required to fix the defect

Disposition

  • Admit

See Also

References

  1. Yucel, M et al. Evaluation of diaphragm in penetrating left thoracoabdominal stab injuries: The role of multislice computed tomography. Injury. 2015 Sep;46(9):1734-7.