Rupture of the diaphragm

Diaphragmatic rupture after a car accident in a cat, surgical site with transabdominal access. In the picture on the left, the liver that has prolapsed into the chest cavity is visible.

Classification according to ICD-10
S27.8	Injury to other specified intrathoracic organs - diaphragm
ICD-10 online (WHO version 2019)

A rupture of the diaphragm is called a rupture of the diaphragm and is usually caused by trauma . If the operation is not performed on time, the risk of death is very high. Children are often affected; 66 to 90 percent of the rupture occurs on the left side of the diaphragm.

causes

Although (or because) a rare complication of a thoracic trauma, according to various sources, it is one of the most frequently overlooked injuries from thoracoabdominal trauma, even with appropriate investigation, at a rate of up to 62 percent, especially since other damages are often in the foreground.

Diaphragmatic ruptures occur primarily in connection with traffic accidents, be it with pedestrians, car occupants or (playing) children who are overlooked by reversing cars. Car accidents are the most common cause of diaphragmatic ruptures in animals too.

Corresponding injuries can occur directly as stab , stake or gunshot wounds or indirectly as a result of compression of the chest (see chest trauma ) or the abdomen (see abdominal trauma ). A rupture of the diaphragm is a rare side effect of the underlying trauma, but usually only occurs in the context of serious accidents, so that accompanying injuries and the resulting circulatory instability must be taken into account.

X-ray of a right-sided diaphragmatic rupture in a dog with dislocation of the liver (4), spleen (7) and stomach (8). 3 shows the left diaphragm attachment line obtained.

Diagnosis

This and the fact that an inconspicuous x-ray finding ( chest x-ray in two planes and abdominal overview ) does not exclude a diaphragmatic rupture immediately after the trauma leads to the fact that diaphragmatic ruptures are overlooked and can lead to dramatic consequences: The displacement of abdominal organs into the chest cavity leads to ( additional) impairment of breathing (see also paradoxical breathing ). In this case, bowel sounds can in the chest auscultation be.

treatment

Surgical treatment takes place via a transthoracic or transabdominal approach. The wound can usually be treated with a diaphragmatic suture - now also laparoscopically .

Individual evidence

1. ↑ Laparoscopic treatment of the right-sided diaphragmatic rupture; Christian Graeb u. a .; 121st Congress of the German Society for Surgery. Berlin, 27.-30. April 2004. Düsseldorf, Cologne: German Medical Science; 2004.
2. ↑ ^{a b} Thoracic trauma, traumatic diaphragmatic rupture: www.kinderchirurgie.ch ( Memento of the original from October 4, 2006 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. 
3. ↑ Laparoscopic treatment of the right-sided diaphragmatic rupture. Christian Graeb - Surgical Clinic and Polyclinic, LMU Munich, Großhadern Clinic. 121st Congress of the German Society for Surgery

Web links

• AWMF online: Guideline diaphragmatic hernia, diaphragmatic defect of the German Society for Pediatric Surgery

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !