eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics

Diaphragmatic Injuries: Follow-up

Author: Michelle Welsford, MD, FRCP(C), FACEP, Associate Professor, Division of Emergency Medicine, Department of Medicine, McMaster University; Staff Emergency Physician, Emergency and Prehospital Services, Medical Director, Paramedic Base Hospital Program, Hamilton, Ontario Health Sciences
Contributor Information and Disclosures

Updated: Oct 21, 2008

Follow-up

Complications

  • Early deaths usually are a result of associated injuries not the diaphragmatic tear. Mortality rate ranges from 5-30%.
  • Serious morbidity usually is related to reexpansion pulmonary edema or to the laparotomy.
  • Paralysis or incoordination of the diaphragm is common, but more than 50% of these conditions resolve.
  • The late complications of an undiagnosed traumatic hernia include all of the following: bowel herniation, incarceration, and strangulation; tension hemothorax secondary to massive bowel herniation; pericardial tamponade from herniation into the pericardial sac; and diaphragmatic paralysis that may recover after repair.
  • Death and significant morbidity rarely are related to delayed diagnosis. However, incarceration of herniated abdominal contents can lead to infarction or rupture with disastrous consequences.

Prognosis

  • The prognosis is generally good with immediate repair.

Miscellaneous

Medicolegal Pitfalls

  • Failure to diagnose or a delayed diagnosis: A delay in diagnosis of a small diaphragmatic tear may result in significant morbidity or death from herniation of abdominal contents.
 


More on Diaphragmatic Injuries

Overview: Diaphragmatic Injuries
Differential Diagnoses & Workup: Diaphragmatic Injuries
Treatment & Medication: Diaphragmatic Injuries
Follow-up: Diaphragmatic Injuries
References
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References

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Further Reading

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Keywords

diaphragmatic injuries, diaphragmatic injury, diaphragmatic rupture, diaphragmatic tear, diaphragm, abdominal injuries, diagnostic peritoneal lavage, blunt diaphragmatic ruptures, blunt trauma, penetrating trauma, knife wounds, gunshot wounds, motor vehicle crash, blunt traumatic injuries, penetrating traumatic injuries

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Contributor Information and Disclosures

Author

Michelle Welsford, MD, FRCP(C), FACEP, Associate Professor, Division of Emergency Medicine, Department of Medicine, McMaster University; Staff Emergency Physician, Emergency and Prehospital Services, Medical Director, Paramedic Base Hospital Program, Hamilton, Ontario Health Sciences
Michelle Welsford, MD, FRCP(C), FACEP is a member of the following medical societies: American College of Emergency Physicians, American Heart Association, Canadian Association of Emergency Physicians, Canadian Medical Association, National Association of EMS Physicians, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Medical Editor

Steven A Conrad, MD, PhD, Chief, Department of Emergency Medicine; Chief, Multidisciplinary Critical Care Service, Professor, Department of Emergency and Internal Medicine, Louisiana State University Health Sciences Center
Steven A Conrad, MD, PhD is a member of the following medical societies: American College of Chest Physicians, American College of Critical Care Medicine, American College of Emergency Physicians, American College of Physicians, International Society for Heart and Lung Transplantation, Louisiana State Medical Society, Shock Society, Society for Academic Emergency Medicine, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

David B Levy, DO, FACEP, FAAEM, Chairman, Department of Emergency Medicine, St Elizabeth Health Center; Associate Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine
David B Levy, DO, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Informatics Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

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