Traumatic diaphragmatic injury algorithm

TDI: traumatic diaphragmatic injury; ATLS: advanced trauma life support; CT: computed tomography; MRI: magnetic resonance imaging.
* Consider MRI in pregnant patients.
¶ Same signs as suspicion for TDI above.
Δ There are cases of isolated TDI with subtle presentation. Laparoscopy is appropriate in a hemodynamically stable patient with an equivocal CT scan and appropriate mechanism for TDI.
◊ When TDI occurs more centrally, repair may be needed in the first look phase to effectively exclude the abdominal compartment from the thoracic compartment and prevent herniation.
§ Typical left-sided posterior diaphragmatic injuries.
¥ The need to place mesh in the setting of associated organ injury should prompt careful evaluation to rule out bowel injury and ensure control of all other injuries. A second look should be considered.