Diaphragmatic injury in children.

Injury to the diaphragm is rare in children. From 1972 to 1990, 13 children were treated for diaphragmatic injury at Ste-Justine and Montreal Children's hospitals. There were seven boys and six girls, ranging in age from 1 to 15 years (average, 7.5 years). Eight patients sustained penetrating trauma and five patients sustained blunt trauma. Nine patients had associated injuries, most commonly involving the liver. All thirteen patients underwent exploratory laparotomy with repair of the diaphragm. There were two deaths, both unrelated to the diaphragmatic trauma. All surviving patients recovered without sequelae. One patient underwent cosmetic repair of a chest wall deformity 9 years after injury. Diaphragmatic injury must be considered in any child suffering blunt or penetrating thoracoabdominal trauma. Because of the increased compliance of the thoracic cage in children, rupture of the diaphragm can occur without signs of external injury. Morbidity and mortality can be minimized by a high index of suspicion, prompt recognition, and surgical repair of even the smallest diaphragmatic injury.