<prompt> A 26-year-old man, Raju met with an accident is brought to emergency. The person accompanying him informed that a truck run over the patient. CXR reveals an air fluid level in left lung nasogastric tube got coiled upward into left chest. Which of the following is the next best step in management of this patient?Placement of a chest tube on left sideThoracotomyDiagnostic peritoneal lavageLaparotomy  <response>: This is likely a case of acute diaphragmatic rupture and should be treated with immediate laparotomy Etiology of diaphragmatic rupture: 1. Penetrating trauma 2. Blunt trauma - Comprehensive force applied to pelvis or abdomen Clinical features: Most injuries are Silent Patients presents with SS of injury of associated organs Late complication of diaphragmatic injury - Herniation Most common organ herniated - Stomach colon Small intestine Investigations VATS Video assisted Thoracoscopy Laparoscopy evaluate the other abdominal organs Treatment: Operative repair in all cases Bergquist Traid: Rib fracture Spine or Pelvic fracture Traumatic rupture of diaphragm 