Closed diaphragmatic rupture

Diaphragmatic injuries

A 6-year series of 26 patients with diaphragmatic injury is presented, 15 with rupture from blunt injuries and 11 after penetrating injuries. All had associated injuries and seven died because of these. The diagnosis may be difficult and was consequently delayed in two patients. Eleven ruptured diaphragms were diagnosed before operation, 14 on the operating table and one at autopsy (dead on arrival). Herniation of abdominal organs was seen in nine of 15 patients after blunt injuries. In most patients repair was via laparotomy using absorbable sutures. It is still essential that the surgeon should be aware of the possibility of the diagnosis and the associated severe injuries.

Chest trauma in children

A series of 94 children with chest trauma is reviewed. Mortality is related to age and the number of major systems involved. Closed chest injuries were preponderent and were most often caused by road traffic accidents that accounted for all fatalities. The most frequent injury was pulmonary contusion. Fractures of ribs in children are more common than is generally supposed.