Penetrating thoracoabdominal trauma complicated by isolated diaphragmatic injury

Abstract

The incidence of left-sided diaphragmatic injuries due to penetrating thoracoabdominal trauma is high and poses a diagnostic and therapeutic challenge. Isolated diaphragmatic injury occurs in up to 30% of cases.

Laparoscopy has shown better outcomes compared to open surgery. The laparoscopic approach allows for a thorough exploration of the abdominal cavity to manage diaphragmatic injuries.

Patient survival depends more on the severity of associated non-diaphragmatic injuries, and in many cases, the diaphragmatic laceration is the least morbid. Therefore, its surgical repair tends to yield favorable outcomes in the absence of other severe injuries.

A 40-year-old male patient was admitted with a stab wound to the left thoracoabdominal region. He presented with stable hemodynamics, pain at the site of the traumatic injury, decreased breath sounds in the left hemithorax, and no signs of peritoneal irritation. The FAST exam was negative, and chest and abdominal X-rays revealed a mild left pneumothorax without pneumoperitoneum.

An exploratory laparoscopy was performed, revealing an approximately 2 cm left diaphragmatic injury, which was repaired with primary suturing. No concomitant intra-abdominal injuries were identified. Additionally, a left chest tube was placed. The patient had an uneventful recovery and was discharged on the third postoperative day.