Traitement chirurgical des ruptures traumatiques du diaphragme

Diaphragmatic rupture occurs in major blunt trauma; it is a marker of severe injury. The risk for diaphragmatic rupture is 3-fold higher in case of lateral impact than after frontal impact. The diagnosis of diaphragmatic rupture remains problematic due to the poor specificity of clinical signs. Radiology shows the elevation of abdominal viscera rather than the discontinuity of the diaphragm. So, its identification is frequently missed in the acute phase, and it may be discovered later. Once the diagnosis has been established, the surgical treatment consists of a suture by an abdominal approach, often preferred to the thoracic approach which has only few indications. Laparoscopy is a new approach that may be used in a patient with a good haemodynamic situation.