Traumatic Diaphragm Injuries: A Comprehensive Review

Traumatic Diaphragmatic Injury although rare, results in high rates of mortality and morbidity if missed. Despite advances in imaging, diagnosis without the presence of a hernia remains difficult and a high index of suspicion must be maintained particularly in penetrating mechanisms of injury. Chest X-ray remains an important tool in early diagnosis. Multi-Detector Computed Tomography improves preoperative diagnosis but is not adequate to rule out smaller injuries or those without the presence of a hernia. Minimally invasive modalities allow for both the diagnosis and repair of suspected injuries in hemodynamically stable patients while avoiding the morbidity and mortality of an open approach. All diaphragmatic injuries require surgical repair. The principles of diaphragmatic injury repair are complete reduction of all abdominal contents and watertight, tension-free closure. Most injuries can be closed primarily, but more complex defects may require the use of prosthetic material or local flaps to achieve closure. Mortality remains primarily dependent on the mechanism of injury and the presence and severity of associated injuries, with little to no additional morbidity if the diaphragm injury is promptly diagnosed and treated. Missed injuries that progress to become chronic diaphragmatic hernias have the potential for high morbidity and mortality.