Primary repair of bilateral diaphragmatic rupture with crural involvement.

A second case of bilateral hemidiaphragmatic rupture with involvement of the esophageal hiatus has been presented. Successful primary repair was accomplished by a transabdominal approach. Blunt diaphragmatic rupture, along with its presentation, diagnosis, and management, are discussed. The first priorities are life-threatening injuries and hemorrhage. Tears of the diaphragm should be considered in all patients with blunt abdominal and thoracic trauma, and when laparotomy or thoracotomy is performed, tears should be searched for visually. With discovery of injury to one hemidiaphragm, injury to the opposite side should be excluded. When identified, bilateral tears should be repaired primarily.