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Laparoscopic cholecystectomy in the pediatric population results in short postoperative hospital stay and has low complication rates. In particular, zero bile duct injuries were noted.

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Traumatic diaphragmatic rupture is a relatively rare entity, with only a few reported pediatric cases. Specific differences from adult traumatic diaphragmatic rupture are found more in the cause and frequency than in diagnosis and treatment of this disease. We present these four cases of traumatic diaphragmatic rupture, which were managed in our department for a six-year period from January 1994 to December 1999. Case ReportsThe charts and radiographs of pediatric patients who had sustained blunt trauma with rupture of the diaphragm were retrospectively reviewed. All patients were admitted to the emergency room (ER) where they were assessed and imaging studies performed. The follow-up on these patients was more than six months. Case 1A 10-year-old boy was struck by a car, and sustained head, chest and abdominal injuries. He was intubated at the scene of the accident and presented to the ER one hour later with shallow respirations, hypotension and unconsciousness. Investigations on admission included chest x-ray, abdominal ultrasound and CT scan. The chest xray showed an opaque right hemi-thorax and the ultrasound and CT scan confirmed the displacement of the right hepatic lobe into the thorax (Figure 1). The patient was initially stabilized and an intravenous cholangiogram was performed to rule out an associated biliary duct injury, which was intact. At laparotomy two hours after admission, the right hepatic lobe was reduced and a large right diaphragmatic laceration with peripheral disruption repaired. No other injuries of the liver were identified. The postoperative course was uneventful. Case 2An eight-year-old boy was struck by a motor vehicle and admitted to the ER, with complaints of abdominal pain, nausea and dyspnea. A chest and abdominal x-ray withbariumconfirmed a leftdiaphragmaticrupture by the presence of a bowel pattern in the chest, and a naso-gastrictube curling up into the chest. At laparotomy, a left diaphragmatic rupture was found. The stomach and transverse colon were reduced from the thorax, and the transverse centro-lateral diaphragmatic rupture was repaired. The postoperative course was uneventful.