[Rupture of the diaphragm of late manifestation].
Twenty one cases of delayed diagnosis of ruptured diaphragm caused by closed trauma are reported: 14 on the left side and 7 on the right side. The clinical signs and the modes of presentation are non-specific. Although the history of thoraco-abdominal trauma and the chest x-ray are sufficient to establish the diagnosis of rupture of the left hemidiaphragm, they can only suggest the diagnosis in cases of righ-sided rupture. The mechanism of rupture is more often due to sudden reflex contraction of the diaphragm against a closed glottis than to excessive abdominal pressure caused by the trauma. Diaphragmatic rupture due to closed trauma causes large tears exposing the patient to a low risk of strangulation of intestinal structures in contrast with ruptures due to a penetrating injury, which causes small tears. The diaphragmatic domes must be systematically explored during laparotomy or thoracotomy performed for thoraco-abdominal trauma.
Service de Chirurgie Thoracique, Centre Chirurgical, Marie-Lannelongue, Le Plessis-Robinson.
B
B
Lenot
F
F
Bellenot
J F
JF
Regnard
P
P
Dartevelle
A
A
Rojas-Miranda
P
P
Levasseur
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006549:Hernia, Diaphragmatic, Traumatic / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012421:Rupture; D013997:Time Factors
Les ruptures du diaphragme de révélation tardive.