A CASE OF TRAUMATIC DIAPHRAGMATIC RUPTURE WITH DELAYED DIAGNOSIS AFTER RIB FIXATION FOR FLAIL CHEST

Abstract

　　A 46-year-old man was hit by a motorcycle while walking on a pedestrian crossing. On admission, he was diagnosed with polytrauma, including left flail chest, multiple bilateral rib fractures, bilateral hemopneumothorax, and severe limb injury. Ventilation support was provided through bilateral chest tube insertion and tracheal intubation. Left rib fixation was performed on day 7 and ventilator support was withdrawn on day 8 of hospitalization. Chest radiography performed on day 9 revealed left diaphragmatic injury and diaphragm repair was performed using an open-abdomen approach on day 10. Traumatic diaphragmatic injury is difficult to diagnose during positive pressure ventilation. In cases of severe chest trauma during positive pressure ventilation, careful examination using roentgenography or computed tomography is required in consideration of the complications associated with traumatic diaphragmatic injury ; if traumatic diaphragmatic injury is difficult to confirm during thoracoabdominal surgery, thoracoscopy should be used.