• Roxana Craciun Saint Pantelimon Emergency Clinical Hospital
  • Vlad Constantin Surgery Department, Saint Pantelimon Emergency Clinical Hospital, Bucharest, Romania & Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
  • Alexandru Carâp Surgery Department, Saint Pantelimon Emergency Clinical Hospital, Bucharest, Romania & Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
  • Bogdan Socea Surgery Department, Saint Pantelimon Emergency Clinical Hospital, Bucharest, Romania & Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Keywords: diaphragmatic injury, minimally invasive surgery, trauma, penetrating wound, laparoscopic surgery


Traumatic diaphragm injuries (TDI) are infrequent but can have profound implications for respiratory function. Penetrating chest trauma, particularly stab wounds, poses unique challenges due to small lesion sizes. The incidence of TDI, ranging from 1% to 8%, is higher in penetrating trauma. Left-sided diaphragmatic injuries predominate, potentially linked to assailants being predominantly right-handed. Imaging for TDI is challenging, with contrast-enhanced computed tomography being the gold standard, though limitations persist. We present a case of a 45-year-old woman with a left chest stab wound, illustrating the importance of timely diagnosis and intervention. Clinical presentation included pain on inspiration and signs of ethanol intoxication, but no signs of respiratory distress. Imaging revealed a diaphragmatic injury, prompting exploratory laparoscopy, confirming a two-centimeter laceration that was repaired with nonabsorbable sutures. No other incidents were reported during hospitalization.

TDI mortality rates vary (1%-30%), influenced by associated injuries. Minimally invasive approaches are recommended in stable patients, with thoracoscopy preferred. Prompt diagnosis and intervention are essential, given the risk of complications if treatment is delayed. This case underscores the importance of a high index of suspicion in penetrating chest trauma, ensuring rapid surgical intervention for improved patient outcomes.


[1] M. DeBarros and M. J. Martin, “Penetrating Traumatic Diaphragm Injuries,” Curr. Trauma Rep., vol. 1, no. 2, pp. 92–101, Jun. 2015, doi: 10.1007/s40719-015-0012-0.
[2] P. P. Lopez et al., “Diaphragmatic Injuries: What Has Changed over a 20-Year Period?,” Am. Surg., vol. 76, no. 5, pp. 512–516, May 2010, doi: 10.1177/000313481007600520.
[3] J. D. Lewis et al., “Traumatic diaphragmatic injury: Experience from a level I trauma center,” Surgery, vol. 146, no. 4, pp. 578–584, Oct. 2009, doi: 10.1016/j.surg.2009.06.040.
[4] A. Agrusa et al., “Right diaphragmatic injury and lacerated liver during a penetrating abdominal trauma: case report and brief literature review,” World J. Emerg. Surg., vol. 9, no. 1, p. 33, Dec. 2014, doi: 10.1186/1749-7922-9-33.
[5] W. C. Hanna and L. E. Ferri, “Acute Traumatic Diaphragmatic Injury,” Thorac. Surg. Clin., vol. 19, no. 4, pp. 485–489, Nov. 2009, doi: 10.1016/j.thorsurg.2009.07.008.
[6] E. Reitano, S. P. B. Cioffi, C. Airoldi, O. Chiara, G. La Greca, and S. Cimbanassi, “Current trends in the diagnosis and management of traumatic diaphragmatic injuries: A systematic review and a diagnostic accuracy meta-analysis of blunt trauma,” Injury, vol. 53, no. 11, pp. 3586–3595, Nov. 2022, doi: 10.1016/j.injury.2022.07.002.
[7] G. Sermonesi et al., “Cesena guidelines: WSES consensus statement on laparoscopic-first approach to general surgery emergencies and abdominal trauma,” World J. Emerg. Surg., vol. 18, no. 1, p. 57, Dec. 2023, doi: 10.1186/s13017-023-00520-9.
[8] G. R. Harrison, “The Anatomy and Physiology of the Diaphragm,” in Upper Gastrointestinal Surgery, in Springer Specialist Surgery Series. , London: Springer-Verlag, 2005, pp. 45–58. doi: 10.1007/1-84628-066-4_4.
[9] R. Sacco, S. Quitadamo, N. Rotolo, D. Di Nuzzo, and F. Mucilli, “Traumatic diaphragmatic rupture: personal experience,” Acta Bio-Medica Atenei Parm., vol. 74 Suppl 2, pp. 71–73, 2003.
[10] C. W. Sliker, “Imaging of Diaphragm Injuries,” Radiol. Clin. North Am., vol. 44, no. 2, pp. 199–211, Mar. 2006, doi: 10.1016/j.rcl.2005.10.003.
[11] A. Hassankhani et al., “Diagnostic utility of multidetector CT scan in penetrating diaphragmatic injuries: A systematic review and meta-analysis,” Emerg. Radiol., vol. 30, no. 6, pp. 765–776, Oct. 2023, doi: 10.1007/s10140-023-02174-1.
[12] D. L. Clarke, B. Greatorex, G. V. Oosthuizen, and D. J. Muckart, “The spectrum of diaphragmatic injury in a busy metropolitan surgical service,” Injury, vol. 40, no. 9, pp. 932–937, Sep. 2009, doi: 10.1016/j.injury.2008.10.042.
[13] J. G. Mariadason, M. H. Parsa, A. Ayuyao, and H. P. Freeman, “Management of Stab Wounds to the Thoracoabdominal Region: A Clinical Approach,” Ann. Surg., vol. 207, no. 3, pp. 335–340, Mar. 1988, doi: 10.1097/00000658-198803000-00019.
[14] A. Leppäniemi and R. Haapiainen, “Occult Diaphragmatic Injuries Caused by Stab Wounds:,” J. Trauma Inj. Infect. Crit. Care, vol. 55, no. 4, pp. 646–650, Oct. 2003, doi: 10.1097/01.TA.0000092592.63261.7E.
[15] A. M. Zarour, A. El-Menyar, H. Al-Thani, T. M. Scalea, and W. C. Chiu, “Presentations and outcomes in patients with traumatic diaphragmatic injury: A 15-year experience,” J. Trauma Acute Care Surg., vol. 74, no. 6, pp. 1392–1398, Jun. 2013, doi: 10.1097/TA.0b013e31828c318e.
[16] L. Miller, E. V. Bennett, H. D. Root, J. K. Trinkle, and F. L. Grover, “Management of Penetrating and Blunt Diaphragmatic Injury:,” J. Trauma Inj. Infect. Crit. Care, vol. 24, no. 5, pp. 403–409, May 1984, doi: 10.1097/00005373-198405000-00006.
[17] E. Onursal and F. Vinces, “Management Algorithm for Acute and Chronic Diaphragmatic Injuries,” in Clinical Algorithms in General Surgery, S. Docimo and E. M. Pauli, Eds., Cham: Springer International Publishing, 2019, pp. 653–656. doi: 10.1007/978-3-319-98497-1_160.
[18] E. E. Moore, D. V. Feliciano, and K. L. Mattox, Eds., Trauma, Eighth edition. New York: McGraw-Hill Education, 2017.