Diaphragmatic rupture pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Pathophysiology
Although the mechanism is unknown, it is proposed that a blow to the abdomen may raise the pressure within the abdomen so high that the diaphragm bursts. Blunt trauma creates a large pressure gradient between the abdominal and thoracic cavities; this gradient, in addition to causing the rupture, can also cause abdominal contents to herniate into the thoracic cavity. Abdominal contents in the pleural space interfere with breathing and cardiac activity. They can interfere with the return of blood to the heart and prevent the heart from filling effectively, reducing cardiac output. If ventilation of the lung on the side of the tear is severely inhibited, hypoxemia (low blood oxygen) results.
Usually the rupture is on the same side as an impact. A blow to the side is three times more likely to cause diaphragmatic rupture than a blow to the front.
Location
Between 50 and 80% of diaphragmatic ruptures occur on the left side[1] It is possible that the liver, which is situated in the right upper quadrant of the abdomen, cushions the diaphragm. However, injuries occurring on the left side are also easier to detect in X-ray films. Half of diaphragmatic ruptures that occur on the right side are associated with liver injury. Injuries occurring on the right are associated with a higher rate of death and more numerous and serious accompanying injuries. Bilateral diaphragmatic rupture, which occurs in 1–2% of ruptures, is associated with a much higher death rate (mortality) than injury that occurs on just one side.