Traumatic rupture of the right diaphragm

The diagnosis and management of diaphragmatic injuries still presents a problem. In a recently published series the proportion of these injuries which is initially overlooked remains at between 20 and 40%, and the post-operative mortality at 21%. Based on two personal cases of rupture of the right diaphragm and on an analysis of published series, we endeavour to lay down some guidelines for the diagnosis and treatment of this injury. Appropriate radiological investigations include chest x-ray (which should be repeated), abdominal ultrasound and thoraco-abdominal tomodensitometry. The treatment is surgical. The preferred route of access in the elective case is via the thorax, but in emergency, in the absence of a pre-operative diagnosis, an abdominal route may be indicated.