Diaphragmatic rupture: a single-institution experience and review of the literature

BACKGROUND Diaphragmatic rupture (DR) is a rare and potentially life-threatening event caused by trauma or spontaneously. DR occasionally occurs several months after the injury. Chest X-ray and computed tomography are the most effective diagnostic methods. Delay in DR diagnosis occurs frequently. This study aimed to examine and improve our understanding of the etiology, clinical presentation, and management of DR. METHODS This study was performed at the Emergency and General Surgery Department of Fondazione I.R.R.C.S. Ca Granda, Ospedale Policlinico in Milan (Italy). Patients diagnosed with DR between 2001 and 2011 who underwent surgery were included, and their data were retrospectively collected. RESULTS Fourteen patients were diagnosed with DR, mainly left-sided DR. Road traffic collisions were the main causes (86%). DR diagnosis was preoperatively established in eight patients (57%). Chest X-ray was diagnostic in 50% of the patients and computed tomography in three patients (60%). Twelve patients had a diaphragmatic hernia. DR was repaired with a mesh in two patients. Mean hospital stay was 16.6 days. CONCLUSION Difficulty in achieving early diagnosis of DR is due to its nonspecific presentation. High index of suspicion is needed. Its treatment is using surgery involving reduction of the viscera and repair of the diaphragm defect.