title: Right diaphragmatic injury and lacerated liver during a penetrating abdominal trauma: case report and brief literature review.
abstract: BACKGROUND
  Diaphragmatic injuries are rare consequences of thoracoabdominal trauma and they often occur in association with multiorgan injuries. The diaphragm is a difficult anatomical structure to study with common imaging instruments due to its physiological movement. Thus, diaphragmatic injuries can often be misunderstood and diagnosed only during surgical procedures. Diagnostic delay results in a high rate of mortality.
  
  
  METHODS
  We report the management of a clinical case of a 45-old man who came to our observation with a stab wound in the right upper abdomen. The type or length of the knife used as it was extracted from the victim after the fight. CT imaging demonstrated a right hemothorax without pulmonary lesions and parenchymal laceration of the liver with active bleeding. It is observed hemoperitoneum and subdiaphragmatic air in the abdomen, as a bowel perforation. A complete blood count check revealed a decrease in hemoglobin (7 mg/dl), and therefore it was decided to perform surgery in midline laparotomy.
  
  
  CONCLUSIONS
  In countries with a low incidence of inter-personal violence, stab wound diaphragmatic injury is particularly rare, in particular involving the right hemidiaphragm. Diaphragmatic injury may be underestimated due to the presence of concomitant lesions of other organs, to a state of shock and respiratory failure, and to the difficulty of identifying diaphragmatic injuries in the absence of high sensitivity and specific diagnostic instruments. Diagnostic delay causes high mortality with these traumas with insidious symptoms. A diaphragmatic injury should be suspected in the presence of a clinical picture which includes hemothorax, hemoperitoneum, anemia and the presence of subdiaphragmatic air in the abdomen.
authors.affiliation: Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Via L. Giuffrè, Palermo 5 90127, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Agrusa
authors.affiliation: Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Via L. Giuffrè, Palermo 5 90127, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Romano
authors.affiliation: Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Via L. Giuffrè, Palermo 5 90127, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Chianetta
authors.affiliation: Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Via L. Giuffrè, Palermo 5 90127, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: De Vita
authors.affiliation: Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Via L. Giuffrè, Palermo 5 90127, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Frazzetta
authors.affiliation: Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Via L. Giuffrè, Palermo 5 90127, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Buono
authors.affiliation: Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Via L. Giuffrè, Palermo 5 90127, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Sorce
authors.affiliation: Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Via L. Giuffrè, Palermo 5 90127, Italy.
authors.forename: Gaspare
authors.initials: G
authors.lastname: Gulotta
keywords: Diaphragmatic injury; Diaphragmatic repair; Liver laceration; Penetrating abdominal trauma; Stab wound