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Arch Surg. 2002;137(8):972. doi:.
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Figure 1. Chest radiograph after placement of the nasogastric tube, demonstrating coiling of the tube in the chest.

Traumatic diaphragmatic rupture from a blunt mechanism is a relatively uncommon injury that occurs when there is a sudden increase in the pleuroperitoneal pressure gradient against a contracted diaphragm.1Although left-sided ruptures are more common, the patient's signs and symptoms may vary from relatively asymptomatic to hemodynamically unstable with severe associated injuries.2,3Our patient's symptoms of left-sided thoracoabdominal pain associated with ipsilateral decreased breath sounds and associated shortness of breath were consistent with the diagnosis.

The findings on the chest x-ray film may be confused with other pulmonary injuries but coiling of the nasogastric tube in the thoracic cavity is diagnostic (Figure 1). Once the diagnosis is made, no further tests are needed and surgical exploration is mandatory. If the findings on chest x-ray film are nondiagnostic, further evaluation by computed tomography, ultrasound, or other studies may be helpful in the hemodynamically normal patient.47

After assessment of her great vessels by a spiral computed tomography scan, the patient underwent an exploratory celiotomy and repair of the left hemidiaphragm, with preservation of the phrenic nerve. Her postoperative course was unremarkable and she was discharged on the seventh postoperative day.

Corresponding author: John A. Daller, MD, PhD, Department of Surgery, 6.166 Old John Sealy Hospital, 301 University Blvd, Galveston, TX 77555-0533.

Schumpelick  VSteinau  GSchluper  IPrescher  A Surgical embryology and anatomy of the diaphragm with surgical applications. Surg Clin North Am. 2000;80213- 239
Link to Article
Rodriguez-Morales  GRodriguez  AShatney  CH Acute rupture of the diaphragm in blunt trauma: analysis of 60 patients. J Trauma. 1986;26438- 444
Link to Article
Ilgenfritz  FMStewart  DE Blunt trauma of the diaphragm: a 15-county, private hospital experience. Am Surg. 1992;58334- 338
Guth  AAPachter  HLKim  U Pitfalls in the diagnosis of blunt diaphragmatic injury. Am J Surg. 1995;1705- 9
Link to Article
Killeen  KLMirvis  SEShanmuganathan  K Helical CT of diaphragmatic rupture caused by blunt trauma. AJR Am J Roentgenol. 1999;1731611- 1616
Link to Article
Somers  JMGleeson  FVFlowers  CD Rupture of the right hemidiaphragm following blunt trauma: the use of ultrasound in diagnosis. Clin Radiol. 1990;4297- 101
Link to Article
Madden  MRPaull  DEFinkelstein  JL  et al.  Occult diaphragmatic injury from stab wounds to the lower chest and abdomen. J Trauma. 1989;29292- 298
Link to Article

Tables

References

Schumpelick  VSteinau  GSchluper  IPrescher  A Surgical embryology and anatomy of the diaphragm with surgical applications. Surg Clin North Am. 2000;80213- 239
Link to Article
Rodriguez-Morales  GRodriguez  AShatney  CH Acute rupture of the diaphragm in blunt trauma: analysis of 60 patients. J Trauma. 1986;26438- 444
Link to Article
Ilgenfritz  FMStewart  DE Blunt trauma of the diaphragm: a 15-county, private hospital experience. Am Surg. 1992;58334- 338
Guth  AAPachter  HLKim  U Pitfalls in the diagnosis of blunt diaphragmatic injury. Am J Surg. 1995;1705- 9
Link to Article
Killeen  KLMirvis  SEShanmuganathan  K Helical CT of diaphragmatic rupture caused by blunt trauma. AJR Am J Roentgenol. 1999;1731611- 1616
Link to Article
Somers  JMGleeson  FVFlowers  CD Rupture of the right hemidiaphragm following blunt trauma: the use of ultrasound in diagnosis. Clin Radiol. 1990;4297- 101
Link to Article
Madden  MRPaull  DEFinkelstein  JL  et al.  Occult diaphragmatic injury from stab wounds to the lower chest and abdomen. J Trauma. 1989;29292- 298
Link to Article

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