We read with great interest the article by Morales et al.1 The authors conclude that a digital examination through a thoracoabdominal stab wound is both sensitive and specific for detecting occult diaphragmatic injuries (DI). The article suggests that digital examination could replace accepted diagnostic modalities for such injuries.
Detecting DI after penetrating thoracoabdominal trauma remains a difficult task. The consequences of missed or delayed diagnosis are tremendous. Noninvasive modalities have proved inadequate in recognizing DI. Laparotomy, despite high negative exploration rates and significant morbidity, remains the gold standard for diagnosing DI. Laparoscopy and thoracoscopy have been well described for demonstrating DI with minimal morbidity.2,3 Visualization of the entire hemidiaphragm remains the common theme, regardless of modality, for detecting occult injuries. The width of the chest alone is not amenable to a complete evaluation of the diaphragmatic dome by digital examination.
Maxey TS, Reece TB, Young JS. Stop the Pendulum. Arch Surg. 2002;137(6):746. doi: