Diaphragmatic Rupture Research Articles

Postoperative Diaphragmatic Liver Herniation Diagnosed by Point-of-Care Ultrasound.

Point-of-care ultrasound (PoCUS) is a sensitive and specific tool in early identification of malignant pathologies in unstable patients leading to improved outcomes. Postoperative diaphragmatic rupture is rare, can be life-threatening, and is difficult to diagnose. This report describes a 62-year-old women undergoing thoracoscopic right hemidiaphragm plication with acute postoperative hemodynamic instability. Bedside PoCUS identified hepatic herniation into the thorax causing cardiac compression and lateral displacement, which lead to expedited imaging and surgical reexploration.

Anaesthetic Management of Non Traumatic Diaphragmatic Hernia as a Co-existing Disease: Combined Spinal Epidural to Rescue

Diaphragmatic hernia is a congenital or acquired defect in diaphragm, resulting in herniation of abdominal viscera into thoracic cavity. Acquired diaphragmatic hernia are seen mostly in patients with blunt or penetrating abdominal injuries. Nontraumatic acquired diaphragmatic hernias have been reported in literature but are extremely rare. Anaesthetic management of a patient presenting with nontraumatic diaphragmatic hernia as a co-existing disease offer unique challenges and considerations. This report was about the successful anaesthetic management of a 66-years-old male. He had Osteoarthritis (OA) of left knee with long standing massive right diaphragmatic hernia as a co-existing disease. He was scheduled for left Total Knee Replacement (TKR). Combined Spinal Epidural (CSE) with low dose Subarachnoid Block (SAB) was the anaesthetic technique of choice. Femoral sciatic block is an alternate technique of anaesthesia for such patients.

Traumatic diaphragmatic rupture with liver laceration in a 2-year-old child after blunt abdominal trauma: A case report

Diaphragmatic rupture after blunt abdominal trauma is a rare entity in pediatric age group. We report a 2-year-old child who presented to us with respiratory distress after he fell from bike. Initial evaluation had a suspicion of pneumothorax, but computed tomography scan confirmed that he had a diaphragmatic tear along with herniation of abdominal contents in left hemithorax. The child was managed successfully with open surgical approach. Since there are no specific signs and symptoms to diagnose this condition, high index of suspicion should be kept in all cases of abdomino-thoracic injuries.

Hipertensão intra-abdominal secundária à ruptura diafragmática crônica em um cão

ABSTRACT: Intra-abdominal hypertension (IAH) is the persistent increase of intra-abdominal pressure (IAP) that could be caused by several pathologies. It is capable of promoting organ dysfunction, thereby increasing the mortality rate of human patients. As for cats and dogs, there are still few reports on how this pressure can be monitored and treated as a routine for admitted and hospitalized animals and on its relationship with the mortality of the patients. Therefore, the objective of this paper was to report a case of IAH secondary to chronic diaphragmatic rupture in a dog, which was treated with a temporary abdominal closure (TAC). A bitch was admitted to the veterinary hospital to undergo an elective ovariohysterectomy when it was diagnosed with a diaphragmatic rupture and displacement of the liver and intestinal loops in the chest. After repositioning these structures in the abdominal cavity, tension was observed in the abdomen. A temporary abdominal closure was then performed with a Bogota bag. Immediately after the surgery, the IAP was measured, presenting a value of 15 mmHg, indicating that there was an increase in intra-abdominal pressure. The animal was hospitalized, and IAP was monitored. After 24 hours, IAP was 5.8 mmHg when the Bogota bag was removed, and definitive celiorraphy was performed. The patient showed satisfactory clinical progress and was discharged 72 hours after the surgical procedure. The treatment used for IAH proved to be effective and contributed to the quick and satisfactory recovery of the patient.

Diaphragmatic Hernia Developed after Radiofrequency Ablation for Treatment of Hepatocellular Carcinoma: Reports of Three Cases

Introduction: Radiofrequency ablation (RFA) has been widely accepted treatment for hepatocellular carcinoma (HCC) as primary choice for small HCC or alternative for unresectable cases. Because of the safety and effectiveness of procedure with a low mortality rate and a low major complication rate, the popularity of RFA has gradually increased. As one of rare complication of RFA, diaphragmatic hernia can occur after the procedure. There have been only ten case reports of diaphragmatic hernia developed after RFA for HCC in the literature. Methods: We experienced and reviewed the three cases of diaphragmatic hernia following RFA for HCC. Results: The patients presented abdominal pain and vomiting, and computed tomography and chest PA revealed diaphragmatic hernia showing colonic loops in the thoracic cavity. Duration from RFA to development of symptoms was 19 months, 23 months and 38 months, respectively. The location of HCC were hepatic dome, namely at the segment 7 in two cases and segment 4a in one case. One case were suspected diaphragmatic thermal injury at the time of RFA on post-RFA CT, however follow-up CT after 3 months shows no diaphragmatic injury or bowel herniation. For the treatment of diaphragmatic hernia, we performed emergency operation of diaphragmatic repair in two cases. However one case was tried to repair diaphragmatic defect, but the operative repair was not possible due to severe adhesion. Conclusions: Patients who have undergone RFA for HCC adjacent to the diaphragm should be carefully followed up for possible development of diaphragmatic hernia.

Missed Traumatic Diaphragmatic Hernia: Presentation and Outcome of Surgery

Background: Diaphragmatic insults are the most frequently overlooked injuries in trauma patients. Sometimes it is difficult for trauma physicians to detect diaphragmatic injuries because they are clinically silent. Nevertheless, the precise determination of this hernia is crucial, as missed traumatic diaphragmatic hernia (MTDH) may lead to serious complications. Objective: To comprehend MTDH more readily regarding the presentation and evaluation of surgical management outcomes. Methods: All patients diagnosed with MTDH admitted to the emergency department for surgery at the period from January 2010 to March 2018 were included in the study. We evaluated our cases as regard age, gender, clinical presentation, type of trauma, time since trauma, site of the hernia, surgical technique, complications, and mortality. Results: 25 patients with MTDH were included, 76% were males, mean age was 33.3 years. 92% were left-sided, while 8% were right-sided. 56% of cases were detected within 20 to 40 years of age. Penetrating trauma was the cause in 76 % of cases, blunt trauma in 16%. The stomach and colon were the commonest herniated organs in 64% and 56 % respectively. Dyspnea, abdominal pain, and vomiting were the commonest presentation. Thoracotomy was performed in all patients. Chest infection, pneumonia, ARDS, and empyema were the commonest complications. 3 (12%) cases of mortality in our study. Conclusion: every effort should be done to detect diaphragmatic injury in trauma patients, and surgeons should have a high index of suspicion, for early diagnosis, to prevent complications with subsequent high morbidity and mortality.

Missed Traumatic Diaphragmatic Hernia: Presentation and Outcome of Surgery

Background: Diaphragmatic insults are the most frequently overlooked injuries in trauma patients. Sometimes it is difficult for trauma physicians to detect diaphragmatic injuries because they are clinically silent. Nevertheless, the precise determination of this hernia is crucial, as missed traumatic diaphragmatic hernia (MTDH) may lead to serious complications. Objective: To comprehend MTDH more readily regarding the presentation and evaluation of surgical management outcomes. Methods: All patients diagnosed with MTDH admitted to the emergency department for surgery at the period from January 2010 to March 2018 were included in the study. We evaluated our cases as regard age, gender, clinical presentation, type of trauma, time since trauma, site of the hernia, surgical technique, complications, and mortality. Results: 25 patients with MTDH were included, 76% were males, mean age was 33.3 years. 92% were left-sided, while 8% were right-sided. 56% of cases were detected within 20 to 40 years of age. Penetrating trauma was the cause in 76 % of cases, blunt trauma in 16%. The stomach and colon were the commonest herniated organs in 64% and 56 % respectively. Dyspnea, abdominal pain, and vomiting were the commonest presentation. Thoracotomy was performed in all patients. Chest infection, pneumonia, ARDS, and empyema were the commonest complications. 3 (12%) cases of mortality in our study. Conclusion: every effort should be done to detect diaphragmatic injury in trauma patients, and surgeons should have a high index of suspicion, for early diagnosis, to prevent complications with subsequent high morbidity and mortality.

Double Blow Injury: Left diaphragmatic eventration with colonic perforation following blunt trauma

This is a 35-year-old male patient who attended the emergency service after presenting assault by third parties 48 hours prior to admission with blunt objects. A chest radiograph was performed with evidence of a left pneumothorax and a radiolucent image in the left basal region. The patient goes to the operating room and under general anaesthesia, a diagnostic laparoscopy is started with evidence of traumatic left diaphragmatic eventration with stomach and colon, the content reduction is performed with evidence of transverse colon perforation and intestinal material in the thorax, thorough cleaning of the thoracic and abdominal cavity is performed, diaphragmatic closure left endopleural tube and terminal colostomy of the transverse colon is performed. Blunt diaphragmatic lesions represent a relatively uncommon event, with an estimated prevalence of 0.2%-7% in patients admitted to an Emergency Department because of blunt trauma. The various mechanisms responsible for traumatic diaphragmatic hernia in blunt injuries include a rapid increase in intracavitary pressure or shearing forces on a stretched diaphragm or an avulsion mechanism from its attachment points. Left-sided ruptures are more often seen than right-sided ones (70– 80% vs. 15–24% cases). Surgical approaches, such as thoracotomy, laparotomy, and thoracotomy with laparotomy, are often used for the treatment of a diaphragmatic rupture. The overall mortality rate reported in the literature ranges from 4.3 to 37% in a series of penetrating and blunt injuries, respectively. Diaphragmatic injuries due to blunt trauma are rare; require a high degree of suspicion from the physician and the performance of specific studies such as a thoracoabdominal computed tomography. Surgical management is necessary for all diaphragmatic lesions and can be performed laparoscopically.

A Case of Spontaneous Diaphragmatic Rupture with Strangulation Ileus

A Case of Spontaneous Diaphragmatic Rupture with Strangulation Ileus

Travma Sonrası Karaciğerin Toraksa Herniyasyonu: Geç Tanı Almış Diyafragma Rüptürü

The translocation of the intraabdominal organs into the intrathoracic cavity via the injured area in the diapragm after blunt or penetrated trauma is called traumatic rupture of the diapragm.The translocation of intrabdominal organs into the intrathoracic cavity is a rare, well known, but easily overlooked complication. In cases of severe traumatic events the diagnosis may be skipped due to hemodynamic instability of the patient which may delay treatment. We reported a patient with diaphragmatic rupture diagnosed 1.5 months after a blunt thoracic trauma.

A tale of traumatic diaphragmatic hernia

A traumatic diaphragmatic hernia is uncommon which accounts for 0.8 to 1.6%. In Blunt or penetrating abdominal injury, the patient presents as early or delayed respiratory distress or intestinal obstruction. We present the 55-year old female with a road traffic accident (pedestrian versus two-wheeler) with left-sided chest pain and breathlessness, left shoulder and leg pain referred to our institute. On examination, left hemithorax decreased breath sound and bowel sound was present, chest compression test positive, normal bowel sound in the abdomen, restricted left shoulder movement and abnormal mobility of shaft of left tibia and fibula. A plain X-ray of the chest and abdomen showed bowel shadow in the left hemithorax up to the apex. Computed tomography (CT) of thorax and abdomen shows herniation of stomach, transverse colon, omentum in the left hemithorax with collapsed left lung. A plain X-ray of the left shoulder shows neck of scapula fracture, left leg both bone fracture. Suggesting traumatic diaphragmatic hernia took emergency surgery, laparotomy was made intact stomach, transverse colon, omentum reduced with no injuries, radially placed diaphragmatic rent of size 10 cm × 5.5 cm through which left lung inferior lobe visualized, medial edge of rent close to the pericardial pad of fat. Other solid organs normal, left thoracic drain was fashioned. Rent was closed with interrupted polypropylene with intraabdominal drain. Left leg both bone fracture was done with tibial nailing and left neck of scapula fracture managed conservatively. Abdominal approach is sufficient rather than a thoracoabdominal approach given associated intraabdominal injuries, nowadays minimal access approaches preferred.

Transdiaphragmatic Chest Wall Herniation

The combination of traumatic simultaneous diaphragmatic rupture and chest wall herniation remains rare, with 42 cases of traumatic transdiaphragmatic intercostal hernia (TDIH) reported in the literature since 1946. An accurate count of cases is difficult to obtain, as TDIH nomenclature has been variable.1-5 Risk factors for traumatic TDIH are not well established. As these injuries are uncommon, best management techniques have yet to be established. Reported repair techniques include primary closure, closure with mesh, and implantation of prosthetic or autologous material. We present our single-center series of 7 patients, the largest reported to our knowledge, and discuss the challenges of repairing these difficult injuries. After obtaining institutional review board approval, data were abstracted from the electronic medical record on all adults who underwent evaluation and treatment for traumatic TDIH between July 2014 and January 2019. Of the 7 cases of traumatic TDIH, 6 patients developed TDIH secondary to cough; the seventh patient presented with chronic chest wall pain after an episode of heavy lifting. All patients were obese or overweight. Pain and a "popping sensation" were the most common presenting symptoms. All patients underwent operative intervention with primary repair of the diaphragm and suture approximation of the ribs. 3 patients had onlay mesh repair of the chest wall and/or abdominal wall. 1 patient had plating of his rib fracture. 3 patients had a recurrence of the intercostal portion of the hernia No patients have undergone reoperation thus far. While previously thought to more commonly occur on the left side due to the protective effects of the diaphragm,2 the majority in this series had right-sided injuries. Herniation through the ninth-10th interspace remains the most common location.4 Computed tomography imaging should be used for diagnosis and operative planning. It is best to manage these hernias acutely to re-establish normal anatomy. Mesh may be required in delayed reconstructions of if the chest wall cannot be re-approximated. Rib plating should be considered in cases of instability or flail. High rates of complications are not unexpected given the complicated and rare nature of the injury. Given the high rate of intercostal hernia recurrence, it is likely that mesh repair or should be more often used in the treatment of this injury.

The course of delayed right-sided post-traumatic diaphragmatic hernia with dislocation of the liver into the chest cavity

A rare clinical case of delayed post-traumatic hernia of the right dome of the diaphragm with dislocation of the liver into the chest cavity without dysfunction of the liver, lungs, and the absence of hemodynamic disturbances is described. At the outpatient stage, during the planned fluorography in patient N, in the projection of the lower lobe of the right lung, a single round-shaped darkening with dimensions 11499 mm was revealed. To clarify the diagnosis, the patient was admitted to the clinic of hospital surgery military medical Academy named after S. M. Kirov in a planned manner. Based on the results of the examination and a thorough collection of anamnesis, the final diagnosis was established: Right-sided post-traumatic hernia with dislocation of the liver into the chest cavity. This complication is extremely rare. The literature describes isolated clinical examples of such a pathology. This is due to the peculiarities of the anatomical structure, namely, with the protective function performed by the liver. It prevents other organs of the peritoneal cavity from lobbying into the chest cavity. However, in this unique case, liver migration after a closed abdominal trauma was described. It is not unimportant that this clinical case was accompanied by a meager clinical picture, the absence of complaints from patient N., and normal indicators of the method performance of laboratory diagnostic techniques. The mortality rate for diaphragm ruptures can reach 31% in the first days after injury. Therefore, the diagnosis of diaphragmatic hernia requires exclusion in all patients with chest and / or abdominal trauma.

Case presentation of a patient with an onset of psychotic disorder, polytraumatized by defenestration from 10th floor, with thoraco-lumbar SCI and multiple somatic fractures, with favorable neuro-motor and psychiatric evolution after rehabilitation

Introduction: Traumatic fractures of the spine are most common at the thoracolumbar junction and can be a source of great disability. Most of them occur due to motor vehicle injuries and falls from a height. Since these are high-velocity injuries, thoracolumbar fractures are commonly associated with other injuries like rib fractures, pneumo-hemothorax, and rarely great vessel injuries, hemopericardium and diaphragmatic rupture. Materials and Methods: In this article - having the patient and the THEBA Bioethics Committee approval (no. 3159/30.01.2020) – it is presented the case of a 26-year-old patient who suffered a polytrauma due to defenestration from the 10th floor - about 30 m high -resulted in thoraco-lumbar SCI associated with other severe injuries, hospitalized in Neuromuscular Clinical Division by transfer from the Neurosurgery Clinic of our hospital, for neuromotor recovery, presenting a L1 AIS/ Frankel C quadriplegia and neurogenic bladder. During the hospitalization, the patient presented psychomotor agitation, food and medication rejection, which is why repeated psychiatric evaluations were requested and performed. Following the recovery program, the patient's evolution was favorable: recovered the weight deficit, improved the motor control and sensitivity, the urethral indwelling catheter was suppressed and the intermittent catheterization program was started with later regaining of the micturition control. The patient was assessed functionally using the following scales: AIS/Frankel, modified Ashworth, Functional Independence Assessment (FIM), Life Quality Assessment (QOL), FAC International Scale, Independence Assessment Scale in Daily Activities (ADL/IADL). Results:The patient benefited from a complex program of neuromuscular rehabilitation, with a favorable evolution, with the increasing scores from the evaluated scales and, thus, with a final performance of walking with support on short distances, as well as a sphincter reeducation with the neurogenic bladder remission. Conclusions: Associating interdisciplinary approach with a customized rehabilitation program in a patient with an onset of psychotic disorder, polytraumatized by defenestration from the 10th floor, with thoraco-lumbar SCI and other severe injuries led to neuromotor and psychiatric improvements, and sphincter function reeducation with an important improvement in patient's quality of life. Keywords: neuromuscular rehabilitation, traumatic spinal cord injury, psychiatric disorder, polytrauma,

Numerical and Experimental Studies of Ballistic Compression Process in a Soft Recovery System

Abstract A ballistic compression type soft recovery system can stop a free-flying supersonic projectile in a controlled manner. The moment such a projectile enters the System, a normal shock gets created and starts hurtling down, to kick off a train of events involving shock reflections, diaphragm rupture, shock merger, creation of new shocks and contact discontinuities, and expansion wave-shock interactions. A good understanding of these phenomena and sensitivity of the System's performance to changes in design parameters is needed to design an efficient soft recovery system. Unfortunately, not much information is available about this. The present work fills this gap. We have developed a numerical model for the system and conducted sensitivity analyses using four design parameters; pressure, molecular weight, the ratio of specific heats, and temperature of gas used in the system. We show that while there is a strong, positive correlation between the first two parameters and projectile deceleration, the other two parameters are less critical. We conducted experiments to corroborate our conclusions and improve our numerical model. Post such improvements, we found the difference between simulation and experimental data to be acceptable. Experiments also confirmed the findings of our sensitivity studies. Finally, we conducted a two-dimensional finite volume analysis to understand the reasons underlying the residual difference between our numerical and experimental data. We show that such differences are due to pressure-rise at a point once a shock passes by it, and such a rise in pressure is attributable to boundary layer effects.

Delayed diagnosis of isolated acute diaphragmatic injury: Repair via thoracic approach is a better option

Delayed diagnosis of isolated acute diaphragmatic injury: Repair via thoracic approach is a better option

Role of Multi-Detector Computed Tomography in Assessment of Blunt Abdominal Trauma in Pediatric Patients

Abstract Background: Abdominal trauma in pediatrics is common. The delay in diagnosis and treatment could increase the complications rate. Using Computed tomography (CT) has been the gold standard in assessment of hemodynamically stable patients with blunt abdominal trauma. Aim of Study: Was to identify the value of the MDCT in the assessment of different abdominal injuries as a result of blunt abdominal trauma in pediatricpatients. Patient and Methods: This prospective study carried out on 50 pediatric patients with blunt abdominal trauma, those patients underwent multi-detector CT abdomen with intrave-nous contrast for detection of intra-abdominal injuries. This study was conducted between October 2018 and October 2019. The data collected were tabulated and analyzed statis-tically. Results: MDCT study of pediatric patients was able to diagnose and grade solid and non-solid organ injuries. The spleen was the most commonly injured solid organ (56%) followed by the liver (46%) and kidney (32%). MDCT findings were able to limit the need for surgical intervention, where most of the cases were managed conservatively. Conclusions: MDCT candetect and accurately assess the grading of injuries of solid organs, non-solid hollow viscus organs. Also it perfectly diagnoses diaphragmatic injuries and bone fractures. Vascular and non-vascular complications were diagnosed accurately with triphasic contrast enhanced CT protocol. MDCT is of a great help in deciding the mostpref-erable management by detecting life-threatening conditions such as the active bleeding. Also, it primarily suggests non-operative management protocol as the intensity of care and the hospital stay duration.

Delayed left traumatic diaphragmatic hernia mimicking acute coronary syndrome

Traumatic diaphragmatic hernias (DH) represent only a small percentage of all DH. Injury is mostly caused by severe blunt or penetrating trauma. DH may be recognized during the period of hospitalization immediately following trauma. Here, we present the case of DH in a 33-year-old male who presented with typical acute coronary syndrome-related symptoms with significant electrocardiography changes. The case is unique due to the occurrence of the DH with trauma and its delayed presentation with acute coronary symptoms. A high index of suspicion should be raised if the patient had a previous history of trauma and chest X-ray findings.

Left-sided blunt diaphragmatic rupture with a massive hemothorax due to complete transection of the left renal artery

Left-sided blunt diaphragmatic rupture with a massive hemothorax due to complete transection of the left renal artery

MDCT OF ABDOMINAL WALL LUMBAR HERNIAS

Purpose:To review the anatomical landmarks of the abdominal wall lumbar region and its normal appearance on multidetector computed tomography (MDCT) and to briefly describe the MDCT features of lumbar hernias.Diagnosis of traumatic diaphragmatic hernia due to blunt abdominal trauma requires a high index of suspicion. This study was conducted to assess the accuracy of multidetector computed tomogram (MDCT) in the diagnosis of traumatic diaphragmatic hernia.Diaphragmatic injuries remain a diagnostic challenge for both radiologists and surgeons. The detection of traumatic diaphragmatic rupture in the acute setting is problematic because specific clinical signs are usually not evident. Furthermore, the high frequency of associated injuries (52–100%) may distract from diaphragmatic injury. In conservatively managed patients, the rate of initially missed diaphragmatic injuries ranges from 12 to 66%, and they may even be overlooked at laparotomy. Diagnosis of a diaphragmatic injury requires a high index of suspicion, as delayed diagnosis increases the chance of visceral herniation and strangulation, which has mortality as high as 60%. Thus, the ability to detect diaphragmatic injuries with noninvasive techniques is increasingly important. Initial reports found CT to have sensitivity equal to that of chest radiography (i.e., 0–50%). Because of a dramatic reduction in motion and beam-hardening artifacts and significant improvement of spatial resolution, especially along the z-axis, helical CT and multisection CT allow better demonstration of most subtle signs of diaphragmatic herniation. In addition, these are also useful tools in the evaluation of patients with multiple traumatic injuries. Traumatic diaphragmatic hernias (TDHs) are sometimes difficult to identify at an early stage and can consequently result in diagnostic delays with life-threatening outcomes. It is the aim of this case study to highlight the difficulties encountered with the earlier detection of traumatic diaphragmatic hernias. Methods: We performed a retrospective search of the imaging report database from November 2007 to October 2011. We retrieved the clinical data and MDCT studies of patients suffering from abdominal wall lumbar hernias. We reviewed the imaging features of abdominal lumbar hernias and compared those with the normal appearance of the lumbar region in asymptomatic individuals.We assessed variables such as age, gender, mechanism of trauma, methods of diagnosis, herniated organs and associated lesions, time of evolution, morbidity, and mortality. Anteroposterior supine chest radiograph, which was performed in all patients, was also analyzed. Computed tomogram (CT) was performed on four-slice MDCT after an IV bolus of iodinated contrast agents. A slice thickness of 4 mm at a pitch of 1.5 was useful to evaluate thorax and abdomen with reconstruction at 1 mm reconstruction increment. An oral contrast agent was given whenever required. Multiplanar reconstruction was done in sagittal and coronal planes. Images were read in lung parenchyma, soft tissues, and bone windows. Findings were analyzed in a prospective manner to evaluate their use as a diagnostic modality as well as to determine their contribution to patient management. Results:We classified lumbar wall hernias as diffuse, superior (or Grynfelt–Lesshaft) and inferior (or Petit) lumbar hernias. We briefly describe the imaging features of each subtype and review the anatomy and MDCT appearance of normal lumbar region.Currently available MDCT provides an excellent opportunity for reviewing the normal anatomy of the wall lumbar region and may be considered a useful modality for evaluating lumbar hernias.Regarding Diaphragmatic hernia following blunt trauma:MDCT is a highly accurate modality for diagnosing traumatic diaphragmatic hernia. In addition, it is fast and compatible with various life-support systems hence, it can be used in acute trauma setting for making a diagnosis and helping in the management.Delayed traumatic diaphragmatic hernias are not common, but can lead to serious consequences once occurred. Early detection of diaphragmatic injuries is crucial to prevent the occurrence of dTDHs. Surgeons should maintain a high suspicion for injuries of the diaphragm in patients who had suffered abdominal or lower chest traumas, especially during the initial surgical explorations. The need for radiographical follow-ups is emphasized to detect diaphragmatic injuries at an earlier stage.