Table 1 Major series reporting cases in the literature of blunt diaphragmatic rupture.

Chughtai T et al. [9]

208 (1986-2003)

Blunt: 208

Right: 135 Left: 47 Bilateral: 4

Abdomen: liver (63,5%), spleen (52,9%), small bowel mesentery (46,2%)... Chest: Rib fracture (75,5%), pulmonary contusion (63,0%), hemothorax (40,4%), hemopneumothorax (22,1%)...

Mean ISS 38.0

93,3% laparotomy 1,4% thoracotomy

60 † within 28 days. Head injury: 25% Intra-abdominal bleeding: 23,2%

Ozpolat B et al. [7]

41 (1996-2007)

Blunt: 20 Penetrating: 21

Right: 12 Left: 28 Bilateral: 1

30 (73%): hemothorax, pneumothorax, liver and rib fractures

Not mentioned.

85% operated before 24 h

6 † (14,6%)

Lunca S et al. [12]

61 (1992-2003)

Blunt: 15 Penetrating: 46

Right: 15 Left: 45 Bilateral: 1

27 hemorrhagic shock

ISS = 24 (6-75)

100% operated before 12 h

9 † 15 complications

Cubukçu A et al. [13]

21 (1995-1998)

Blunt: 9 Penetrating: 12

Right: 12 Left: 9

20 patients with concomitants injuries (Liver in 10 patients) 7 patients with signs or symptoms related to diaphragmatic rupture

Not mentioned.

100% operated before 24 h

3 †

Dajee A et al. [14]

48 (1973-1978)

Blunt: 8 Penetrating: 40

Right: + Left: +++ Bilateral: 1

Intra-abdominal injuries involved the spleen, liver, stomach and colon. 8 patients herniations of intra-abdominal contents.

Not mentioned

100% laparotomy. No use of mesh.

3 † (6%)

Tan KK et al. [16]

14 (2002-2008)

Blunt: 14

Right: 5 Left: 9

8 Splenic laceration, 5 hemothorax and lung injuries, 4 long bone fracture, 4 pelvic fracture, 3 liver laceration, 3 colonic laceration, 3 injury major vessels, 2 kidney laceration, 2 small bowel laceration, 1 gastric perforation.

Median GCS: 14 (3-15) Median ISS: 41 (14-66).

85,7% laparotomy and repair 14,3% surgical intensive care unit.

5 † (33%) Extensive injuries

Matsevych OY. [19]

12 (4 years)

Blunt: 12

Right: 6 Left: 2 Bilateral: 1

100% associated injuries: 5 hemothorax, 4 head injuries, 3 extremity fracture, 3 pelvic fracture, 3 liver laceration, 3 retroperitoneal hematoma.

Not mentioned.

100% laparotomy. 1 patient thoracotomy.

3 † (25%) (Hypovolemic shck, 1 brain injury, 1 cardiac failure)

Bergeron E et al. [20]

160 (April 1, 1984, to March 31, 1999)

Blunt: 160

Right: 31 Left: 126 Bilateral: 3

Abdomen: liver (47%), spleen (50%), small bowel mesentery (38%)... Chest: Rib fracture (31%), pevi (41%), other orthopedic (50%).

ISS = 26.9 (+-11.5)

100% operated between 60 minutes and 21.8 days after injury. 4 had repair of diaphragmatic rupture at a second laparotomy.

14,4%

Brasel KJ et al. [21]

32 (January 1987 through May 1994)

Blunt: 32

Right: 7 Left: 25 Bilateral: 0

Abdomen: liver (47%), spleen (50%), small bowel mesentery (38%)... Chest: Rib fracture (31%), pevi (41%), other orthopedic (50%).

ISS= 32

100% laparotmomy. Sunning suture all patients and 1 patient polypropylene mesh repait.

22,0%

Shapiro MJ et al. [22]

20 (5 years period)

Blunt: 20

Right: 7 Left: 14 Bilateral: 0

Shock 16/20; hemo/pneumothorax 15/20; cerebral injury (12/20); puhnonary contusion 9/20; chest wall contusion 8/20; hepatic injury 8/20; splenic injury 8/20

36 (11-59)

Not mentioned

25,0%

Montresor E et al. [23]

17 (1970 to 1995)

Blunt: 17

Right: 7 Left: 14 Bilateral: 0

52.6% presented at operation with intrathoracic visceral herniation.

Not mentioned.

8 laparotomy. 7 laparotomy and thoracotomy. 4 thoracotomy

15,6%

Esme H et al. [24]

14 (January 2000 and June 2005)

Blunt: 11 Penetrating: 3

Right: 4 Left: 10

Multiple associated injuries were observed in 12 patients (85%)

Not mentioned.

100% laparotomy.

Overall: 7%

Athanassiadi K et al. [25]

41 (1988 to 1997)

Blunt: 41

Right: 15 Left: 24 Bilateral: 2

In 34 patients (94%) involving: spleen (n = 18), rib fractures (n = 17), liver (n = 14), lung (n = 11), bowel (n = 7), kidney (n = 5) and other fractures (n = 21)

Not mentioned.

22 laparotomy 10 thoracotomy 4 laparo-thoracotomy

16.6% (6/36)

Gwely NN. [26]

44 (1998 and 2007)

Blunt: 44

Right: 12 Left: 30 Bilateral: 2

Not mentioned.

31 thoracotomy in 4 laparotomy 3 thoracolaparotomy

13.2% (5/38)

Yalçinkaya I et al. [27]

26 (1996-2005)

Blunt: 26

Right: 8 Left: 18

Multiple associated injuries were observed in patients (96%). Thorax herniation of organs (45%).

Not mentioned.

15 thoracotomy 7 laparotomy 4 thoraco-laparotomy

3 † (11.5%)