Acute traumatic diaphragmatic injury.

Acute diaphragmatic hernia is a result of diaphragmatic injury that accompanies severe blunt or penetrating thoracoabdominal trauma. It is frequently diagnosed early on the trauma bay chest radiograph or CT scan of the chest. However, in the absence of a hernia, it may be difficult to identify traumatic diaphragmatic injury on conventional imaging. A midline laparotomy is the advocated approach for repair of acute diaphragmatic trauma because it offers the possibility of diagnosing and repairing frequently associated intraabdominal injuries. In hemodynamically stable patients with penetrating left thoracoabdominal trauma, the incidence of injury to the diaphragm is very high, and thoracoscopy or laparoscopy is recommended for the diagnosis and repair of a missed diaphragmatic injury. Repair with nonabsorbable simple sutures is adequate in most cases, and the use of mesh should be reserved for chronic and large defects. Outcomes of acute diaphragmatic hernia repair are largely dictated by the severity of concomitant injuries, with the Injury Severity Score being the most widely recognized predictor of mortality.