Citation

Pantelis D, Burger C, Hirner A, Wolff M. Chirurg 2006; 77(4): 360-366.

Vernacular Title

Indirekte traumatische Zwerchfellruptur. Unfallmechanismus und Diagnostik.

Affiliation

Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefässchirurgie der Universität Bonn.

Copyright

(Copyright © 2006, Holtzbrinck Springer Nature Publishing Group)

DOI

10.1007/s00104-005-1103-1

PMID

16362352

Abstract

BACKGROUND: Indirect diaphragmatic rupture (DR) is defined as acquired complete split of the diaphragm after blunt trauma and occurs in 1-5% of massively traumatized patients. The diagnosis is often difficult. However, particular trauma mechanisms and associated injuries may suggest the existence of DR. METHODS: A retrospective study was done of 21 consecutive patients from 1993 to 2004 at an university hospital. RESULTS: This study revealed a striking combination of DR with pelvic fractures (12/21, 57%). Of 19 polytraumatized patients, diagnosis was made initially in 13 (68%) and with a delay in six (32%). Right-sided injuries were common (8/21, 38%). Thus a 'protective' function of the liver does not exist. Diaphragmatic rupture can be missed in ventilated patients until extubation leads to herniation of abdominal organs into the thorax. CONCLUSIONS: Diaphragmatic rupture should be excluded in all severely abdominally traumatized patients, in particular those with concomitant pelvic fracture. Computed tomography with oral contrast medium is diagnostic in most cases. Access by laparotomy should be preferred after acute trauma, since additional intra-abdominal injuries are frequent.

Language: de