Diaphragmatic perforation without penetration into the peritoneum in sharp thoracoabdominal injury

ABSTRACT

In diaphragm injuries, especially those which are left sided, it is recommended to repair diaphragm perforation to prevent complications. However, we found two cases of diaphragm injuries including two 27 and 31 years old men who were injured with stab but they were not repaired at thoracoscopy. Both patients were haemodynically stable. Chest X-ray and CT-scan were not in favor of diaphragm perforation in both cases. The thoracoscopic finding was a 1.5 [case 1] and 1 cm teasing on the left diaphragm on the left muscular past of the diaphragm without penetrating into the abdominal cavity and with an intact peritoneum documented by probing. Due to intact peritoneum and absence of peritoneal signs, no further thoracotomy was performed. The patients were followed for 6 months with CXR and also physical examination. They did not develop any complication on the follow-up. In conclusion, in spite of diaphragm injuries, since peritoneum was intact in both cases, neither underwent thoracotomy which is invasive. They were asymptomatic during the 6 months of the follow up