Diaphragmatic injuries.

From 1973 through 1978, 48 patients with diaphragmatic injuries from blunt or penetrating trauma to the chest and the upper part of the abdomen were seen at this medical center. Penetrating injuries were the cause of diaphragmatic perforation in 40 patients, while blunt injury was responsible in the remaining eight patients. The mean age of the patients was 30 years. Associated major trauma to other organ systems which accompanied the diaphragmatic lacerations accounted for three deaths. The extent of the diaphragmatic disruptions varied from 1 to 12 centimeters. There was not correlation between the size and location of the laceration and morbidity or mortality. The sequelae of strangulation of gastrointestinal viscera, mediastinal shift and delayed hernia were found in four patients. Eight patients had herniation of intra-abdominal contents, two as a result of penetrating trauma and six as a result of blunt trauma. Strangulation and necrosis of the intestine occurred in three patients, two of whom had delayed treatment. Deliberate effort must be made to identify diaphragmatic perforation at the time of the initial evaluation of injured patients with trauma to the thorax and abdomen. Prompt recognition and repair are required for survival.