Risk Factores of Delayed Diaphragmatic Ruptures

From 1981 to 2001 12 patients with chronic occult diaphragmatic disruption have been managed at our Clinic. All but two were lefsided hernias with delayed presentation, at least 6month after injury. In the majority of the cases the fact of blunt thoracic and/or abdominal trauma have been forgotten and the injurys to the diaphragm were not suspected befor admission, resulting fals diagnosis of tension pneumothorax in one. In 3 other cases rupture of the left-seded diaphragm was missed at prior laparotomy, a recurrent left-sided hernia was interpreted at the previous Institute as posttraumatic phrenicus nerv paly and erroneous diagnosis of massive hiatal hernia was done in the thired patient. In case of a young patient the leftsided rupture with gastric stangulation developed 7days after trauma, representing a veritable two-steps rupture.