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. Laparoscopy or video-assisted thoracoscopic surgery (VATS) can be used in hemodynamically stable patients. VATS has greater accuracy (sensitivity and specificity close to 100%) and helps to avoid the risk of tension pneumothorax

[19]. However, we feel that VATS is best reserved for stable patients when intraabdominal and contralateral diaphragmatic injuries are excluded. Grimes, in 1974, described the three phases of the rupture of the diaphragm: an initial acute phase, at the time of the injury to the diaphragm; [17] a delayed phase associated with transient herniation of the viscera, thus accounting for absent or intermittent non-specific symptoms; and the obstruction phase involving the buy BI 10773 complication of a long-standing herniation, manifesting as obstruction, find more strangulation and posterior rupture [18]. The typical organs that herniate into the thoracic cavity include the stomach,

spleen, colon, small bowel and liver, Repair with non-absorbable simple sutures is adequate in most cases, and the use of mesh should be reserved for chronic and large defects. Thus, all surgeons must be vigilant during any exploratory laparotomy to exclude any associated diaphragmatic injury. Mortality strictly related to diaphragmatic rupture is minimal, and is usually caused by the associated injuries. The most common causes of death Oxymatrine reported in the literature are shock, multiple organ failure and head injuries [9]. Outcomes of acute diaphragmatic hernia repair are

largely dictated by the severity of concomitant injuries, with the Injury Severity Score being the most widely recognised predictor of mortality. Delayed diagnosis may increase mortality by up to 30% [8]. The rate of initially missed diaphragmatic ruptures or injuries in nonoperatively managed patients, therefore, ranges from 12 to 60% [3]. Blunt diafragmatic rupture can easily be missed in the absence of other indications for prompt surgery, where a thorough examination of both hemidiaphragms is mandatory. A high index of suspicion combined with repeated and selective radiologic evaluation is necessary for early diagnosis. Acute diaphragmatic hernia is a result of diaphragmatic injury that Osimertinib mw accompanies severe blunt or penetrating thoracoabdominal trauma. It is frequently diagnosed early on the trauma by chest radiograph or CT scan of the chest. Non-adverted diaphragmatic injury resulting from the chronic phase of a diaphragmatic hernia will probably require surgery to repair the defect. Conclusions Blunt diaphragmatic rupture can lead to important morbidity and mortality. It is a rare condition, usually masked by multiple associated injuries, which can aggravate the condition of patients.