Traumatska ruptura desne hemidijafragme

The right hemidiaphragm rupture, caused by blunt force, occurs rarely and often is overlooked because of immediate management of life-threatening injuries. Our paper presents 31-year old female patient, admitted as emergency case due to traffic accident injuries. Physical examination revealed diminished respiratory mobility of the right hemothorax, along with the impaired respiratory sound to the right infrascapular aspect, diffuse painful sensitivity of the abdomen and limited mobility of the lower extremities. X-ray examination of the chest verified the tight hemidiaphragm elevation without any signs of bone structure fractures and hydro-pneumothorax. Computerized tomography of the abdomen and small pelvis showed the rupture of the right diaphragmatic cupola with the prolaps of the right hepatic lobe, sacral fracture and fracture of both ischial rami. The surgery verified the rupture of the right hemidiaphragm in transversal direction of about 10 cm long, with partial prolaps of liver to the right hemithorax. Surgical intervention included the insertion of thoracic drain and liver mobilization by severing the falciform ligament. The operation was completed by interrupted sutures of the right hemidiaphragm and hematomas in the retroperitoneum were incised. Postoperative course was uneventful, and oral nutrition was initiated on day 4. The patient was discharged 18 days after the surgery. Preoperative diagnostics, attentive intraoperative examination and early surgical treatment significantly reduce morbidity and mortality of patients with traumatic diaphragmatic rupture.