Diaphragmatic rupture - resuscitation in trauma
Overview
Traumatic diaphragmatic rupture is a significant consequence of blunt or penetrating injury to the lower chest or upper abdomen.
A tear in one hemidiaphragm allows abdominal viscera to herniate into the thoracic cavity, reducing ipsilateral lung volumes, producing mass effect and mediastinal shift, and risking bowel incarceration and ischaemia.
Prompt recognition, resuscitation within the major‑trauma pathway and timely surgical repair are essential; delayed or missed diagnosis is common and dangerous.
Epidemiology and mechanism
- Most commonly follows significant blunt trauma (motor vehicle collisions, crush injuries) or penetrating trauma (stabbings, gunshot wounds) to the lower chest or upper abdomen.
- Left hemidiaphragm is injured more often than right (approximately 3:1); the liver buffers and can mask right‑sided tears.
- Presentation may be immediate (acute herniation) or delayed (weeks to months) when small tears enlarge or viscera gradually herniate.
Relevant anatomy (clinical points)
- The diaphragm is a musculotendinous partition between thorax and abdomen; the central tendon fuses with the fibrous pericardium.
- Attachments: xiphoid process anteriorly; costal margins (lower six ribs) laterally; crura posteriorly (to L1-L3).
- Major apertures: inferior vena cava at T8; oesophagus and vagal trunks at T10; aorta, thoracic duct and azygous vein at T12.
- The right dome normally sits higher than the left; right‑sided defects may be obscured by the liver.