title: Diaphragmatic rupture causing repeated vomiting in a combined abdominal and head injury patient: a case report and review of the literature.
abstract: BACKGROUND
  Diaphragmatic rupture after blunt abdominal injury is a rare trauma condition. Delayed diagnosis is not uncommon especially in the emergency room setting. Associated injuries often shift diagnosis and treatment priorities towards other more life-threatening conditions.
  
  
  METHODS
  We present a challenging case of a young male with combined abdominal and head trauma. Repeated episodes of vomiting dominated on clinical presentation that in the presence of a deep scalp laceration and facial bruising shifted differential diagnosis towards a traumatic brain injury. However, a computed tomography scan of the brain ruled out any intracranial pathology. Finally, a more meticulous investigation with additional imaging studies confirmed the presence of diaphragmatic rupture that justified the clinical symptoms.
  
  
  CONCLUSIONS
  The combination of diaphragmatic rupture with head injury creates a challenging trauma scenario. Increased level of suspicion is essential in order to diagnose timely diaphragmatic rupture in multiple trauma patients.
authors: Department of General Surgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece. simeonid@hotmail.com.
authors: Dimitrios
authors: D
authors: Symeonidis
authors: Michail
authors: M
authors: Spyridakis
authors: Georgios
authors: G
authors: Koukoulis
authors: Grigorios
authors: G
authors: Christodoulidis
authors: Ioannis
authors: I
authors: Mamaloudis
authors: Konstantinos
authors: K
authors: Tepetes