Penetrating Injuries to the Diaphragm

Fig. 39.1

A left lower penetrating chest wound: the high likelihood of diaphragm penetration requires further investigation

Fig. 39.2

Air-filled stomach incarcerated in the chest

Fig. 39.3

The left diaphragm wound was further opened to allow the reduction of intrathoracic content

Fig. 39.4

A stomach with a gangrenous area due to strangulation

Important Points

Penetrating diaphragmatic injuries are diagnostically challenging and need to be actively sought and excluded.
Invasive diagnostic procedures such as laparoscopy or thoracoscopy are the most sensitive modalities to definitively exclude small penetrating injuries.
Multislice CT scanning, FAST, and DPL may contribute to identifying high-risk cases.
Early diagnosis and surgical repair of all left-sided diaphragmatic hernias are essential to reduce the morbidity and mortality of late complications.

Recommended Reading

Clarke DL, Greatorex B, Oosthizen GV, Muckart DJ (2009) The spectrum of diaphragmatic injury in a busy metropolitan surgical service. Injury 40:932–937CrossRefPubMed

Degiannis E, Levy RD, Sofianos C, Potokar T, Florizoone MG, Saadia R (1996) Diaphragmatic herniation after penetrating trauma. Br J Surg 83(1):88–91CrossRefPubMed

Freeman RK, Al-Dossari G, Hutcheson KA, Huber L, Jessen ME, Meyer DM, Wait MA, DiMaio M (2001) Indications for using video-assisted thoracoscopic surgery to diagnose diaphragmatic injuries after penetrating chest trauma. Ann Thorac Surg 72:342–347CrossRefPubMed

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