Laparoscopic repair of a ruptured diaphragm secondary to blunt trauma

Abstract

The diagnosis of acute diaphragmatic rupture can be a challenge for even the most experienced clinician. The treatment of the rupture and its concomitant injuries, particularly in the elderly, can be associated with significant morbidity and mortality. The advent of laparoscopy for both the diagnosis and repair of this condition has allowed a more minimally invasive approach. We present the case of a 70-year-old woman who was hurt in a motor vehicle crash. On admission, her physical exam showed left upper quadrant tenderness and bruising. The chest radiograph was suggestive of a ruptured diaphragm. She was taken to the operating room and explored laparoscopically. After a thorough exploration of all the abdominal contents, a tear in the diaphragmatic hiatus to the right of the esophagus was noted. The stomach and small intestine were returned to the abdomen, and the diaphragmatic rupture was repaired. We conclude that laparoscopic exploration and repair of a ruptured diaphragm in a bluntly injured patient is a safe and effective option in selected cases.