Traumatic injuries of the diaphragm. Experience in 33 cases.

Between 1978 and 1985, 33 patients were treated because of a traumatic injury of the diaphragm. There were 28 males and 5 females, ages ranging from 19 to 54 years, with a mean of 34.5. There were 19 cases of open trauma and 14 were closed injuries. In 3 cases, the diagnosis was established on a delayed basis. Treatment was always surgical, with the following procedures: Laparotomy and chest drainage tube in 7 cases (21%), thoracotomy in 12 cases (36%) and a combined thoracoabdominal approach in 14 (43%). Surgical findings were 19 perforations, 10 tears and 4 crushes. In 11 cases there was gastric intrathoracic migration, in 9 cases pulmonary lesions and in 4 cases liver injuries. There were 4 cases of hospital mortality (12%) and overall 6 cases (18%). It is concluded that the early establishment of the diagnosis and the prompt initiation of therapeutic measures is a fundamental factor in the outcome of diaphragmatic injuries. The surgical approach must be individualized in every case, however we prefer the abdominal approach in acute and left diaphragmatic injuries and the thoracic approach in the case of chronic and right lesions.