Prognostic factors and outcome of traumatic diaphragmatic rupture

MASOUDPOUR, Hassan; BEIGI, Ali Akbar; KHADEMI, Elham Fatemeh; SEHHAT, Siavoush

Prognostic factors and outcome of traumatic diaphragmatic rupture

Ali Akbar BEIGI, (Department of Vascular Surgery, Isfahan University of Medical Sciences, Isfahan, Iran)

Hassan MASOUDPOUR, (Department of Thoracic Surgery, Isfahan University of Medical Sciences, Isfahan, Iran)

Siavoush SEHHAT, (Alzahra Hospital, Department of Surgery, Isfahan University of Medical Sciences, Isfahan, Iran)

Elham Fatemeh KHADEMI (Isfahan Univercity of Technology, Isfahan, Iran)

Ulusal Travma ve Acil Cerrahi Dergisi

1 1

Yıl: 2010 Cilt: 16 Sayı: 3 Sayfa Aralığı: 215 - 219 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Prognostic factors and outcome of traumatic diaphragmatic rupture

Öz:

AMAÇ Travmatik diyafragma fıtıkları, künt ve penetran yaralanmalardan sonra sıklıkla oluşmaktadır. Travmatik diyafragma yırtığı tanısında zorluklar, eşlik eden yaralanmalar ve diyafragma yaralanmalarının sessiz doğası ilk başvuruda geç tanı konmasının en sık nedenleridir. GEREÇ VE YÖNTEM Alzahra Hastanesi?nde Ağustos 2004 ile Haziran 2008 tarihleri arasında post-travmatik diyafragma fıtığı nedeniyle tedavi edilen 34 hastanın (28 erkek, 6 kadın; ortalama yaş 32,3 yıl; dağılım 1-68) tıbbi kayıtları, retrospektif olarak incelendi. BULGULAR Diyafragma yırtığı hastaların 22?sinde (%64,7) sol tarafta, 11?inde (%32,4) sağ tarafta ve 1?inde ise (%2,9) iki taraflıydı. Künt travma, 22 hastada yaralanma (%64,7) nedeniydi. İlk operasyonda tanı, 15 hastada (%44,1) ameliyat öncesinde, 13 hastada (%38,2) ameliyat sırasında koyuldu. Tanı, 6 hastada (%17,7) ilk operasyonda atlandı. Üç hastada, viseral organ strangülasyonu görüldü. Travma başlangıcı ile tanı arasındaki en uzun interval, bir olguda yaklaşık üç yıl oldu. Hastaların 22?sinde (%64,7) eşlik eden birden çok sayıda yaralanma gözlendi ve bunlar en yaygın olarak dalak yaralanması (%38,2), ekstremite kırıkları, hemotoraks (%29,4) ve karaciğer yaralanması (%26,5) şeklindeydi. Dokuz hastada (%26,5) ameliyat sonrası komplikasyonlar gözlendi. İzole künt travmatik rüptür mortalitesi %0 oldu. Hemorajik şok, genç yaş ve eşlik eden yaralanmalar, mortalite ve morbiditeyi anlamlı şekilde arttırdı. SONUÇ Diyafragmatik fıtık insidansının nadir olması gerçeğine karşın, toraks ve karına ilişkin tüm künt ve penetran travmalarda diyafragma fıtığından kuşkulanılmalıdır. Geç komplikasyonların çoğunlukla yüksek morbidite ile birlikte olması nedeniyle, böyle bir yaralanmanın varlığı, tanısal işlemler tamamlanmadan önce ekarte edilmelidir.

Anahtar Kelime:

Konular: Cerrahi

Travmatik diyafragmatik rüptüründe prognostik faktörler ve sonuçlar

Öz:

BACKGROUND Traumatic diaphragmatic hernias commonly occur after blunt and penetrating trauma. The difficulties in diagnosing traumatic diaphragmatic rupture due to coexisting injuries and the silent nature of the diaphragmatic injuries at the first admission are the most common causes of delayed diagnosis. METHODS The medical records of 34 patients (28 male, 6 female; mean age 32.3 years; range 1 to 68) treated for post-traumatic diaphragmatic hernias between August 2004 and June 2008 in Alzahra Hospital were analyzed retrospectively. RESULTS Rupture of the diaphragm was left-sided in 22 (64.7%) and right-sided in 11 (32.4%) and bilateral in 1 (2.9%) of the patients. Blunt trauma accounted for the injuries of 22 patients (64.7%). In the first operation, diagnosis was established preoperatively in 15 patients (44.1%) and intraoperatively in 13 (38.2%). The diagnosis was missed in 6 (17.7%) patients in the first operation. Strangulation of the viscera was seen in three patients. The longest interval between the onset of trauma and diagnosis was approximately three years in one case. Multiple associated injuries were observed in 22 patients (64.7%), the most common of which were spleen injury (38.2%), fractures of the extremities and hemothorax (29.4%) and liver injury (26.5%). Postoperative complications were seen in nine patients (26.5%). Mortality of isolated blunt traumatic rupture was 0%. Hemorrhagic shock, young age and associated injuries significantly increased the mortality and morbidity.CONCLUSION Despite the fact that the incidence of diaphragmatic hernia is uncommon, it should be suspected in all blunt or penetrating traumas of the thorax and abdomen. Because late complications are usually associated with high morbidity, the presence of such an injury should be excluded before terminating the exploratory procedure.

Anahtar Kelime:

Konular: Cerrahi

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Turhan K, Makay O, Cakan A, Samancilar O, Firat O, Icoz G, et al. Traumatic diaphragmatic rupture: look to see. Eur J Cardiothorac Surg 2008;33:1082-5.
2. Shah R, Sabanathan S, Mearns AJ, Choudhury AK. Traumatic rupture of diaphragm. Ann Thorac Surg 1995;60:1444-9.
3. Scharff JR, Naunheim KS. Traumatic diaphragmatic injuries. Thorac Surg Clin 2007;17:81-5.
4. Hanna WC, Ferri LE, Fata P, Razek T, Mulder DS. The current status of traumatic diaphragmatic injury: lessons learned from 105 patients over 13 years. Ann Thorac Surg 2008;85:1044-8.
5. Galan G, Peñalver JC, París F, Caffarena JM Jr, Blasco E, Borro JM, et al. Blunt chest injuries in 1696 patients. Eur J Cardiothorac Surg 1992;6:284-7.
6. Ozgüç H, Akköse S, Sen G, Bulut M, Kaya E. Factors affecting mortality and morbidity after traumatic diaphragmatic injury. Surg Today 2007;37:1042-6.
7. Matsevych OY. Blunt diaphragmatic rupture: four year’s experience. Hernia 2008;12:73-8.
8. Letoquart JP, Kunin N, Lechaux D, Gerard O, Morcet N, Mambrini A. Rupture of the diaphragm in closed traumas: apropos of 28 cases. J Chir (Paris) 1995;132:478-82.
9. Murray JG, Caoili E, Gruden JF, Evans SJ, Halvorsen RA Jr, Mackersie RC. Acute rupture of the diaphragm due to blunt trauma: diagnostic sensitivity and specifcity of CT. AJR Am J Roentgenol 1996;166:1035-9.
10. Guth AA, Pachter HL, Kim U. Pitfalls in the diagnosis of blunt diaphragmatic injury. Am J Surg 1995;170:5-9.
11. Ochsner MG, Rozycki GS, Lucente F, Wherry DC, Champion HR. Prospective evaluation of thoracoscopy for diagnosing diaphragmatic injury in thoracoabdominal trauma: a preliminary report. J Trauma 1993;34:704-9.
12. Seelig MH, Klingler PJ, Schönleben K. Tension fecopneumothorax due to colonic perforation in a diaphragmatic hernia. Chest 1999;115:288-91.
13. Feliciano DV, Cruse PA, Mattox KL, Bitondo CG, Burch JM, Noon GP, et al. Delayed diagnosis of injuries to the diaphragm after penetrating wounds. J Trauma 1988;28:1135-44.
14. Iochum S, Ludig T, Walter F, Sebbag H, Grosdidier G, Blum AG. Imaging of diaphragmatic injury: a diagnostic challenge? Radiographics 2002;22:S103-16.
15. Meyers BF, McCabe CJ. Traumatic diaphragmatic hernia. Occult marker of serious injury. Ann Surg 1993;218:783-90.
16. Brasel KJ, Borgstrom DC, Meyer P, Weigelt JA. Predictors of outcome in blunt diaphragm rupture. J Trauma 1996;41:484-7.
17. Reber PU, Schmied B, Seiler CA, Baer HU, Patel AG, Büchler MW. Missed diaphragmatic injuries and their longterm sequelae. J Trauma 1998;44:183-8.
18. Haciibrahimoglu G, Solak O, Olcmen A, Bedirhan MA, Solmazer N, Gurses A. Management of traumatic diaphragmatic rupture. Surg Today 2004;34:111-4.
19. Sarna S, Kivioja A. Blunt rupture of the diaphragm. A retrospective analysis of 41 patients. Ann Chir Gynaecol 1995;84:261-5.
20. Guth AA, Pachter HL, Kim U. Pitfalls in the diagnosis of blunt diaphragmatic injury. Am J Surg 1995;170:5-9.
21. Leppäniemi A, Pohjankyrö A, Haapiainen R. Acute diaphragmatic rupture after blunt trauma. Ann Chir Gynaecol 1994;83:17-21.
22. Johnson CD. Blunt injuries of the diaphragm. Br J Surg 1988;75:226-30.
23. Bergeron E, Clas D, Ratte S, Beauchamp G, Denis R, Evans D, et al. Impact of deferred treatment of blunt diaphragmatic rupture: a 15-year experience in six trauma centers in Quebec. J Trauma 2002;52:633-40.
24. Williams M, Carlin AM, Tyburski JG, Blocksom JM, Harvey EH, Steffes CP, et al. Predictors of mortality in patients with traumatic diaphragmatic rupture and associated thoracic and/ or abdominal injuries. Am Surg 2004;70:157-63.
25. Shapiro MJ, Heiberg E, Durham RM, Luchtefeld W, Mazuski JE. The unreliability of CT scans and initial chest radiographs in evaluating blunt trauma induced diaphragmatic rupture. Clin Radiol 1996;51:27-30.
26. Madden MR, Paull DE, Finkelstein JL, Goodwin CW, Marzulli V, Yurt RW, et al. Occult diaphragmatic injury from stab wounds to the lower chest and abdomen. J Trauma 1989;29:292-8.
27. Leppäniemi A, Haapiainen R. Occult diaphragmatic injuries caused by stab wounds. J Trauma 2003;55:646-50.

APA	BEIGI A, MASOUDPOUR H, SEHHAT S, KHADEMI E (2010). Prognostic factors and outcome of traumatic diaphragmatic rupture. , 215 - 219.
Chicago	BEIGI Ali Akbar,MASOUDPOUR Hassan,SEHHAT Siavoush,KHADEMI Elham Fatemeh Prognostic factors and outcome of traumatic diaphragmatic rupture. (2010): 215 - 219.
MLA	BEIGI Ali Akbar,MASOUDPOUR Hassan,SEHHAT Siavoush,KHADEMI Elham Fatemeh Prognostic factors and outcome of traumatic diaphragmatic rupture. , 2010, ss.215 - 219.
AMA	BEIGI A,MASOUDPOUR H,SEHHAT S,KHADEMI E Prognostic factors and outcome of traumatic diaphragmatic rupture. . 2010; 215 - 219.
Vancouver	BEIGI A,MASOUDPOUR H,SEHHAT S,KHADEMI E Prognostic factors and outcome of traumatic diaphragmatic rupture. . 2010; 215 - 219.
IEEE	BEIGI A,MASOUDPOUR H,SEHHAT S,KHADEMI E "Prognostic factors and outcome of traumatic diaphragmatic rupture." , ss.215 - 219, 2010.
ISNAD	BEIGI, Ali Akbar vd. "Prognostic factors and outcome of traumatic diaphragmatic rupture". (2010), 215-219.

APA	BEIGI A, MASOUDPOUR H, SEHHAT S, KHADEMI E (2010). Prognostic factors and outcome of traumatic diaphragmatic rupture. Ulusal Travma ve Acil Cerrahi Dergisi, 16(3), 215 - 219.
Chicago	BEIGI Ali Akbar,MASOUDPOUR Hassan,SEHHAT Siavoush,KHADEMI Elham Fatemeh Prognostic factors and outcome of traumatic diaphragmatic rupture. Ulusal Travma ve Acil Cerrahi Dergisi 16, no.3 (2010): 215 - 219.
MLA	BEIGI Ali Akbar,MASOUDPOUR Hassan,SEHHAT Siavoush,KHADEMI Elham Fatemeh Prognostic factors and outcome of traumatic diaphragmatic rupture. Ulusal Travma ve Acil Cerrahi Dergisi, vol.16, no.3, 2010, ss.215 - 219.
AMA	BEIGI A,MASOUDPOUR H,SEHHAT S,KHADEMI E Prognostic factors and outcome of traumatic diaphragmatic rupture. Ulusal Travma ve Acil Cerrahi Dergisi. 2010; 16(3): 215 - 219.
Vancouver	BEIGI A,MASOUDPOUR H,SEHHAT S,KHADEMI E Prognostic factors and outcome of traumatic diaphragmatic rupture. Ulusal Travma ve Acil Cerrahi Dergisi. 2010; 16(3): 215 - 219.
IEEE	BEIGI A,MASOUDPOUR H,SEHHAT S,KHADEMI E "Prognostic factors and outcome of traumatic diaphragmatic rupture." Ulusal Travma ve Acil Cerrahi Dergisi, 16, ss.215 - 219, 2010.
ISNAD	BEIGI, Ali Akbar vd. "Prognostic factors and outcome of traumatic diaphragmatic rupture". Ulusal Travma ve Acil Cerrahi Dergisi 16/3 (2010), 215-219.