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Ruptured Diaphragm
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Overview of Ruptured Diaphragm 
The abdominal cavity is separated from the chest by the right and left diaphragm. These are muscles that not only segregate these areas, but allow change of the volume of the chest cavity. By increasing the volume of the chest cavity, the pressure within the lungs is decreased and air flows into the lungs. When the Chest volume is then reduced, the air is expelled.
Injuries to the diaphragm can result in impaired breathing and circulation. It can lead to rupture of abdominal organs into the chest cavity.
Causes of Ruptured Diaphragm
One of the causes of diaphragmatic injury is blunt abdominal trauma. This form of trauma is frequently associated with either rib fractures or spleen injuries. Unfortunately, some statistics suggest that over 90% of diaphragmatic injuries associated with blunt trauma are initially overlooked. It is thought that this occurs due to obscuration caused by overlying pulmonary injuries. Frequently, these patients are on mechanical ventilation. By increasing the pressure within the chest, these machines help to expand the lungs which may impede herniation of the abdominal contents into the chest.
Somewhere in the range of 3-6% of patients suffering blunt abdominal trauma with also suffer injuries to the diaphragm. Penetrating trauma is the most common cause of diaphragmatic injury.
Due to the protective effect offered by the underlying liver, the left diaphragm is affected more than the right. Most diaphragmatic ruptures originate in the back portion of the diaphragm. The tendency to suffer diaphragmatic injuries in this location is due to the congenital weakness of the fusion between the muscles of the ribs and spine with the muscular attachments of the diaphragm.
The organs that are located within the abdominal cavity may herniated into the chest in up to 95% of left sided lacerations. Again, it is far less common on the right side due to the obstruction offered by the liver. The herniation may be delayed, and initial signs may go undetected or not become apparent for months or years. The stomach is the most frequent abdominal to herniate.
Roughly three-quarters of patients with diaphragmatic rupture have other intra-abdominal injuries, such as injuries to the spleen 60% or pelvic fractures 42%.
Signs and Symptoms of Ruptured Diaphragm
Initially, diaphragmatic hernias are frequently overlooked. Most commonly, this is because of severe injuries in the abdomen or other locations that obscure this type of injury.
However, patients who develop large diaphragmatic defects have critical problems shortly after trauma. This is the result of compromised cardiac and pulmonary function associated with large herniation of abdominal contents into the chest cavity. When the conditions are not as severe, patients may be asymptomatic or have vague symptoms and the diagnosis may be delayed.
Over time, breathing may aggravate the underlying diaphragmatic injury and herniation. This is thought to occur due to the pressure within the chest cavity decrease sing during inspiration. This negative pressure presumably causes gradual herniation of the abdominal organs into the chest and enlargement of the defect.
At times, the intestines may herniate into the chest and become obstructed. This can lead to abdominal pain, nausea and vomiting.
Penetrating injuries produce small lacerations in the diaphragm and organ herniation is uncommon. These are less likely to produce symptoms.
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Medical Content Last Updated on 07/12/2008
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