Laparoscopy in the management of diaphragmatic rupture due to blunt trauma.
BACKGROUND
Traumatic diaphragmatic rupture remains a diagnostic challenge often unrecognized until laparotomy in over 40% of patients and the diagnosis is delayed in a further 15%. This report describes four patients diagnosed at laparoscopy with a ruptured diaphragm.


METHODS
One patient had a left diaphragmatic rupture amenable to laparoscopic repair in the emergency setting. Three patients underwent laparoscopy 2, 7 and 10 days after injury which revealed two right-sided and one extensive left-sided rupture, respectively; each required open repair.


RESULTS
While laparoscopy is an excellent diagnostic tool, particularly in the delayed setting, repair is not possible for right-sided ruptures because of the liver bulk.


CONCLUSIONS
Thoracoscopy in the instance of delayed presentation may offer the best chance for minimal-access diagnosis and treatment when there is suspicion of a right-sided diaphragmatic rupture.
Department of General Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
I
I
Martin
N
N
O'Rourke
D
D
Gotley
M
M
Smithers
D000293:Adolescent; D000328:Adult; D000368:Aged; D003964:Diaphragm / Q000293:injuries* / Q000601:surgery; D004724:Endoscopy; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D012421:Rupture / Q000175:diagnosis / Q000209:etiology; D013906:Thoracoscopy; D014949:Wounds, Nonpenetrating / Q000150:complications*