Diaphragm lesion from steel weapon

The authors report here a case of perforation of diaphragm from an injury from a steel weapon. The patient, a man of 21 age, of Indian nationality, reached in the first-aid reporting to have been assaulted approximately 12 h before and to have been hit in the abdomen and the thorax with a blade. The patient presented with dysponea, thoracic and abdominal pain and a state of shock. On examination there was double penetrating wound in the left dorsal region, an untreatable abdomen and a left hemithorax with clinical signs of pleural effusion. According to hemogas analysis was present an unamissing ipossya. The x-ray examinations showed us a left pleural effusion with the presence of intestinal loops in emithorax. The ultrasonographic examination evidenced an abundant deposit in the abdomen and therefore it was decided to operate surgically through a xifo-umbilical median incision. At the opening of the peritoneum there was an abundance emoperitoneum with presence of lesion from cuts to the diaphragmatic dome near to esophageal hiatus with laceration of the small omentum but with any lesion of the other intra abdominal organs. We provided to mend of the diaphragmatic lesion and a water-drainage was placed in the Douglas, one under the liver and one left thorax drainage according to Boulau. During the operation there was recovery with reinfusion intra operating of approximately 800 cc blood. The post operative period was regular and so the patient was dischanged on the 18th day.