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Diaphragmatic rupture is commonly of traumatic origin and can complicate thoracoabdominal injuries. Some cases are diagnosed after a delay of years. We present three patients with a rupture of the right hemi-diaphragm with herniation of liver fragments, and discuss the diagnostic and therapeutic challenge.

About 5% of the heavy abdominal traumas present a traumatic diaphragm rupture (14). A correct diagnosis of such a rupture is usually not obvious. A collective review by Alivisatos concluded that only 1/3 of the diaphragm ruptures was recognized within the first 24 hours (2). In the department of general surgery of the academic hospitals St-Raphaël and St-Pieter, 38 cases were seen during the last ten years (1970-1980). The diagnosis was made within the first 24 hours (pre- or peroperatively) in 28 cases. In 34 cases, diagnosis was achieved within a week of time and in 36 cases within a year. In only 2 of the cases it was achieved after 1 years time. In this paper two points are especially emphasized, first why a correct diagnosis sometimes is so difficult to reach and second which dangers can result from an unseen diaphragm tear. These points of interest are illustrated by a few remarkables case.

The increased number of automobile casualties increases the frequency of traumatic rupture of the diaphragm. Because of associated serious lesions, diagnosis is easily overlooked. The authors report on 11 cases and give an appraisal of the literature. In 6 patients, diagnosis was made late. The authors discuss the physiopathology, symptoms, clinical data and means of diagnosis. Roentgenography is very important. Surgical cure is always recommended because of the danger of delayed strangulation of the hernia.