The following is an excerpt....
BASICS
Description
- Penetrating injury:
- Violation of the diaphragm by penetrating object (most commonly stab and gunshot wounds)
- May involve any portion of diaphragm
- Blunt injury:
- Increased intra-abdominal or intrathoracic pressure is transmitted to diaphragm, causing rupture.
- Usually due to motor vehicle crashes
- Injuries are more commonly left-sided:
- Left hemidiaphragm has posterolateral embryologic point of weakness.
- Right hemidiaphragm is protected by liver.
- Injuries are larger than with penetrating injury (frequently between 5–15 cm in length).
- Diaphragmatic defects do not heal spontaneously because of pleuroperitoneal pressure gradient:
- May exceed 100 cm H2O during maximal respiratory effort
- Promotes herniation of abdominal contents through rent in diaphragm and into chest
Epidemiology
Incidence
Estimated to be 1–7% in substantial ...
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