Traumatic Diaphragm Injuries: A Comprehensive Review
Matthew J. Martin.
Traumatic Diaphragmatic Injury although rare, results in high rates of mortality and
morbidity if missed. Despite advances in imaging, diagnosis without the presence of a hernia remains
difficult and a high index of suspicion must be maintained particularly in penetrating mechanisms of
injury. Chest X-ray remains an important tool in early diagnosis. Multi-Detector Computed
Tomography improves preoperative diagnosis but is not adequate to rule out smaller injuries or those
without the presence of a hernia. Minimally invasive modalities allow for both the diagnosis and repair
of suspected injuries in hemodynamically stable patients while avoiding the morbidity and mortality of
an open approach. All diaphragmatic injuries require surgical repair. The principles of diaphragmatic injury repair are
complete reduction of all abdominal contents and watertight, tension-free closure. Most injuries can be closed primarily,
but more complex defects may require the use of prosthetic material or local flaps to achieve closure. Mortality remains
primarily dependent on the mechanism of injury and the presence and severity of associated injuries, with little to no
additional morbidity if the diaphragm injury is promptly diagnosed and treated. Missed injuries that progress to become
chronic diaphragmatic hernias have the potential for high morbidity and mortality.
Keywords: Trauma, blunt trauma, diaphragm injuries, diaphragmatic hernia, penetrating trauma, thoracoabdominal trauma.
Rights & PermissionsPrintExport