Diaphragmatic Injuries
- Diaphragm rises to 4th intercostal space in forced expiration!
- Poor signs - 2/3 have other injuries
- 1/3 of diaphragmatic injuries have herniated organs at surgery
- Children herniate more readily
- 30% mortality if bowel incarcerated
- Never spontaneously repairs
- LWE - can induce pneumothorax
- CXR may be normal in 67%
- Barium - whole bowel must be seen
- Ultrasound poor visibility
- CT Poor visibility
- Thoracoscopic poor visibility
- DPL fluid in thoracostomy tube diagnostic!
- Laparoscopy - good visual but risk Pneumothorax /pneumoperitoneum
- 85% represent 3 years (delayed treatment worse prognosis)
- Management = Drain, PPV, Surgery
