Case 1: a 47 year-old man, victim of a motorcycle accident, suffered a frontal abdominal trauma. Upon arrival at the emergency department (ED), a CT scan was performed, revealing a left posterolateral diaphragmatic rupture with herniation of the stomach fundus and body, and a subcapsular hematoma of the right kidney. The patient underwent emergency laparotomy, revealing intraoperative findings of Gleason"s capsule laceration near the falciform ligament extending to the diaphragm, and traumatic rupture of the diaphragm near the left pilar with the gastric fundus intrathoracic. Frenorrhaphy was performed.
Case 2: a 29 year-old man, involved in an accident while practicing motocross, was admitted to the ED, hemodynamically unstable due to abdominal trauma, focused on the left flank. After stabilization, a CT scan was performed, revealing multiple left rib fractures and pneumothorax and a rupture of the left diaphragmatic cupola with a posterocentral defect, causing herniation of the left hepatic lobe, stomach, spleen, pancreatic tail and splenic flexure of the colon. He underwent emergency laparotomy, revealing extensive diaphragmatic laceration of the entire left cupola. Frenorrhaphy was performed.Both postoperative course was uneventful.
Motorcycle accidents, characterized by high-kinetic trauma, continue to be a pressing concern in the field of trauma surgery and emergency medicine. Blunt trauma diaphragmatic injury (TDI), a significant consequence of these accidents and presents unique challenges to healthcare providers due to complexity of diagnosis and the critical nature of the injury. TDI is an underdiagnosed condition that has recently increased in prevalence due to its association with automobile collisions. The management of blunt TDIs is dependent on associated injuries and thoracotomy or laparotomy continue to be the gold standard for TDI. In concurrent intra-abdominal injuries, laparotomy is preferred for emergency and hemodynamically unstable patients.
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