[Injuries of the diaphragm].
Diaphragmal injuries are rare but serious. They are caused by traffic accidents, murder or suicide, fall from height, crush or blast injuries. Mechanisms of diaphragmal rupture may be various: sudden intraabdominal pressure increase, transferred strike force from pelvis (like "contra coup"), direct pressure on one or both hemitoracices, injuries piercing or sclopetar. Negative intraabdominal pressure is convenient for prolapse of abdominal organs into pleural cavity. Ruptures were more often of tendinous than muscular part of diaphragm, and they were more often on left side. Diaphragmal injuries can be: open--percutaneous (thoracoabdominal) and closed--subcutaneous. There are three types of thoracoabdominal injuries: thoracoabdominal, abdominothoracal and thoraco-retroperitoneal. Open diaphragm injuries are followed by shock, hemorrhages, cardiopulmonary disfunction, haematothoracic, peritonitis and other lesions. Closed diaphragmal injuries can be manifested clinically or latent. In the first stage of treatment there is a conservative approach (solving the shock) and in the second stage surgical approach. More often thoracotomy is better than laparotomy and the place of incision depends on localisation of injuries and clinical signs. During last 10 years we surgically treated 19 diaphragmal injuries with mortality rate of 15.9% (3). Most frequent causes of injuries were traffic accidents or sclopetar injury, and the predominant compression. Diaphragmal lesions were a part of thoracoabdominal injuries and politraumas with high mortality rate. The frequency of injuries of other abdominal organs was the following: spleen, lungs, liver, stomach, bowel, kidney, bladder, retroperitoneal blood vessels, legs, arms and pelvis. The treatment of diaphragmal injuries requires multidisciplinary, experienced surgery team with well equipped anaesthesiology and reanimation unit.