Diaphragmatic Injuries: A Surgical Challenge. Report of Forty-one Cases

Özpolat, Berkant; Kaya, İsmail; Yazkan, Rasih; Osmanoglu, Gokhan

doi:10.1055/s-0029-1185579

Cited by 21 publications

(9 citation statements)

References 14 publications

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“…We considered this as a complication because both patients required blood transfusion post operatively. However, this operative morbidity is not higher than 2.4% reported by other authors [21]. …”

Section: Discussioncontrasting

confidence: 54%

The use of laparoscopy in managing penetrating thoracoabdominal injuries in Africa: 83 cases reviewed

2017

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BackgroundThe use of laparoscopy in managing haemodynamically stable patients with penetrating thoracoabdominal injuries in developed countries is wildly practiced, but in Africa, the use of laparoscopy is still in its infancy stage. We reviewed a single centre experience in using laparoscopy in Africa for management of patients with both isolated diaphragmatic injuries as well as diaphragmatic injuries associated with intra-abdominal injuries requiring intervention.MethodsA retrospective analysis of prospectively collected data of patients presenting with penetrating thoracoabdominal injuries was done. All patients offered laparoscopic exploration and repair from January 2012 to December 2015 at Dr. George Mukhari Academic Hospital were analysed. Means (±SD) were presented for continuous variables, and frequencies (%) were presented for categorical variables. All analyses were performed using SAS version 9.3 (SAS Institute, Cary, NC).ResultsA total of 83 stable patients with penetrating thoracoabdominal injuries managed with laparoscopy met the inclusion criteria and were included in the study. The Injury Severity Score ranged from 8 to 24, with a median of 18. The incidence of diaphragmatic injuries was 54%. Majority (46.8%) of patients had Grade 3 (2–10 cm defect) diaphragmatic injury. Associated intra-abdominal injuries requiring intervention were encountered in 28 (62%) patients. At least 93.3% of the patients were treated exclusively with laparoscopy. The morbidity was encountered in 7 (16%) patients; the most common cause was a clotted haemothorax Clavien-Dindo III-b, but only 1 patient required a decortication. There was one non-procedure-related mortality.ConclusionsA success rate of 93% in using laparoscopy exclusively was documented, with an overall 82% uneventful outcome. The positive outcomes found in this study when laparoscopy was used in stable patients with thoracoabdominal injuries support similar work done in other trauma centres. However, in addition, this study seem to suggest that the presence of peritonitis in stable patient is not a contra-indication to laparoscopy and thoracoscopy may be useful especially in right side diaphragmatic injury where the liver can preclude adequate visualization of the entire diaphragm and to thoroughly clean the chest cavity and prevent future complication such as residual clotted haemothorax. Clinical relevance: The presence of peritonitis in stable patients with penetrating thoracoabdominal injury is not a contra-indication to laparoscopy provided the operating surgeon has adequate laparoscopic skills.

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Section: Discussioncontrasting

confidence: 54%

The use of laparoscopy in managing penetrating thoracoabdominal injuries in Africa: 83 cases reviewed

2017

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“…Diyafragma rüptürü majör künt travmalı hastalarda %3-8 oranında görülmektedir (14)(15)(16). Liman (17) diyafragma rüptürlerinin %71 oranında künt, %29 oranında penetran yaralanmalara bağlı olarak oluştuğunu bildirmişdir (17).…”

Section: Discussionunclassified

Thoracic Trauma: 156 Patient Assessment

Yetim¹,

Yetim²,

Duru³

et al. 2011

JAEM

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ÖzetAmaç: Travma nedeniyle acil servise başvuran hastaların, ölüm nedenlerinin önde gelen sebeplerinden önemli bir kısmını, toraks travmaları oluşturmaktadır. Gereç ve Yöntemler: Antakya Devlet Hastanesi ve Mustafa Kemal Üniversitesi Tıp Fakültesi'nde 2008-2010 yılları arasında kliniğimize başvuran 156 toraks travmalı hasta retrospektif olarak değerlendirildi. Hastaların 95'i erkek, 61'i kadındı. Yaş ortalaması künt travmalarda (18-65), penetran travmalarda (13-55) idi. Bulgular: Hastaların 112 'si künt, 44'ü penetran toraks travması nedeniyle başvurdu. Doksan hastada kot fraktürü, 11 hastada klavikula, 9 hastada skapula, 10 hastada sternum fraktürü mevcuttu. İlave olarak 20 hastada yelken göğüs deformitesi saptandı. En sık intratorasik komplikasyon olarak 60 pnömotoraks, 20 hastada hemotoraks, 15 hastada kontüzyo akciğer saptandı. Hastaların 81'ine tüp torakostomi, 10 hastaya mekanik ventilasyon, 6'sına torakotomi, uygulandı. Hastaların ortalama hastanede yatış süresi (7-14) olarak belirlendi. Sonuç: Toraks yaralanmaları hastalar zaman kaybedilmeden acil travmatoloji deneyimi olan genel cerrahi, göğüs cerrahi, ortopedi, beyin cerrahi ve anestezi uzmanlarından oluşan multidisipliner bir ekip tarafından karşılanmalı ve tedavi edilmelidir. Özellikle penetran travmaların genç nesilde artma eğiliminde olması dikkat çekici olmalıdır. (JAEM 2011; 10: 110-3) Anahtar kelimeler: Penetran travma, yaş, multidisipliner yaklaşım Alındığı Tarih: Abstract Objective: To assess trauma patients admitted to the emergency services, because a significant portion of the thoracic trauma cases make up the leading cause of death. Materials and Methods: 156 patients with chest trauma in our clinic admitted to the Antakya public hospital and medical school at the University of Mustafa Kemal between 2008-2010 were retrospectively reviewed. Of the patients, 95 were male and 61 female. The average age of patients with blunt trauma was 18-65years, and with penetrating trauma 13-55. Results: Of the admitted patients,112 had blunt, and 44 had penetrating chest trauma. Rib fractures were present in 90 patients, clavicle in 11 patients, scapula in nine patients, and 10 patients had fracture of the sternum. In addition, flail chest deformity was detected in 20 patients. Pneumothorax was the most common intrathoracic complication in 60 patients, hemothorax in 20 patients, and lung contusion in 15 patients. 81 tubes were inserted in patients with thoracotomy, mechanical ventilation was performed in 10 patients, and thoracotomy in 6. The mean duration of hospitalization was 7-14 days. Conclusion: Patients with chest injuries and traumatology must be met and treated by a multidisciplinary team of experts in thoracic surgery, orthopedics, brain surgery and anesthesia, without losing the experience of emergency general surgery as soon as possible. Penetrating trauma, especially in the younger generation, tends to be increased. (JAEM 2011; 10: 110-3)

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“…Road traffic collisions or lateral intrusions into the vehicle are the most frequent causes of diaphragm rupture [1,4,6,7]. Direct impacts depress the side of the rib cage, and can cause a tear in the diaphragm rib attachments, and even the transverse rupture of the diaphragm [8].…”

Section: Discussionmentioning

confidence: 99%

“…The specific signs of diaphragmatic injury on plain radiographs are a marked elevation of the hemidiaphragm, an intrathoracic herniation of abdominal viscera, the "collar sign", demonstration of a nasogastric tube tip above the diaphragm [19]. Also, in the context of high-energy trauma, when combined with a head injury and pelvic fracture, diaphragmatic trauma should be suspected [7]. The diagnosis is based largely on clinical suspicion and a compatible chest radiograph or CT scan [10].…”

Section: Discussionmentioning

confidence: 99%

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Right-sided diaphragmatic rupture after blunt trauma. An unusual entity

et al. 2011

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Traumatic injuries of the diaphragm remain an entity of difficult diagnosis despite having been recognised early in the history of surgery, especially when it comes to blunt trauma and injuries of the right diaphragm. We report the case of a patient with blunt trauma with right diaphragmatic rupture that required urgent surgical treatment for hepatothorax and iatrogenic severe liver injury. Blunt trauma can cause substantial diaphragmatic rupture. It must have a high index of suspicion for diaphragmatic injury in patients, victims of vehicle collisions, mainly if they have suffered frontal impacts and/or side precipitates in patients with severe thoracoabdominal trauma. The diagnosis can be performed clinically and confirmation should be radiological. The general measures for the management of multiple trauma patients must be applied. Surgery at the time of diagnosis should restore continuity.

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Diaphragmatic Injuries: A Surgical Challenge. Report of Forty-one Cases

Abstract: A high index of suspect is vital for the diagnosis of diaphragmatic injuries in an emergency setting. The type of approach is closely related to the associated injuries.

Cited by 21 publications

References 14 publications

The use of laparoscopy in managing penetrating thoracoabdominal injuries in Africa: 83 cases reviewed

The use of laparoscopy in managing penetrating thoracoabdominal injuries in Africa: 83 cases reviewed

Thoracic Trauma: 156 Patient Assessment

Right-sided diaphragmatic rupture after blunt trauma. An unusual entity

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