A review diaphragmatic injury

Bosanquet, David C.; Farboud, Amir; Luckraz, Heyman

doi:10.1016/j.rmedc.2009.01.002

Cited by 52 publications

(134 citation statements)

References 20 publications

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“…The proportion of blunt to penetrating trauma differs based on the regional characteristics and sociodemographic factors [1][2][3]. Penetrating injuries (10-15%) are more common cause of TDI than blunt trauma (1-7%) [1][2][3]. Motor vehicle crash (MVC) is the most frequent blunt injury mechanism involved in ~ 90% of the cases [4].…”

Section: Introductionmentioning

confidence: 99%

Descriptive Analysis of Right and Left-sided Traumatic Diaphragmatic Injuries; Case Series from a Single Institution

Al-Thani

Jabbour

El‐Menyar

et al. 2018

BEAT

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Objective: To investigate the presentation, management and outcomes of left and right-sided traumatic diaphragmatic injury (TDI) in a single level I trauma center. Methods: This cross-sectional study was conducted during a 7-year period from 2008 to 2015 in a level I trauma center in Qatar. We included all the patients who presented with TDIs during the study period. Data included demographics, mechanism of injury, associated injuries, initial vitals, emergency department disposition, length of ICU and hospital stay, ventilator days, management, and outcomes. The variables were analyzed and compared for patients with left (LTDI) and right (RTDI). Results: A total of 52 TDI cases (79% LTDI and 21% RTDI) were identified with a mean age of 31±11. LTDI patients were more likely to have higher Injury severity scores (p=0.50) and greater AAST organ injury scoring (p=0.661 for all) than RTDI patients. Surgical repair was performed for 85% LTDI vs. 73% RTDI (p= 0.342). Recurrent DIs was reported only in LTDI (5.1% vs. 0.0%; p=0.911). Twelve patients died (9 LTDI and 3 RTDI), of them 5 had associated head injury. Conclusion: This single-institution study confirms that LTDI are more commonly diagnosed than RTDI. Exploratory laparotomy is the most frequent procedure considered for the management of diaphragmatic injuries in the emergency settings. To improve outcomes in patients presenting with TDI, large prospective multicenter studies are needed to standardize the TDI management protocols including the diagnostic workup, timing of surgical intervention, and the most appropriate approach of treatment.

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Section: Introductionmentioning

confidence: 99%

Descriptive Analysis of Right and Left-sided Traumatic Diaphragmatic Injuries; Case Series from a Single Institution

Al-Thani

Jabbour

El‐Menyar

et al. 2018

BEAT

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“…Current surgical practice adopts the use of either absorbable or nonabsorbable sutures. Nevertheless, one group has recently criticized the use of absorbable suture materials based on follow-ups of patients after repair of diaphragmatic injuries [18]. The mattress technique with nonabsorbable sutures was used to repair the diaphragmatic ruptures in our patients.…”

Section: Discussionmentioning

confidence: 99%

Original article An extremely rare clinical condition: isolated post-traumatic diaphragmatic injuries

Taskesen¹,

Arıkanoğlu²,

Önder³

et al. 2012

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Aim: Isolated post-traumatic diaphragmatic injuries are observed less commonly, and the preoperative diagnosis is difficult to make. Material and methods: Thirteen patients with post-traumatic isolated diaphragmatic injury were treated in our department between January 2005 and June 2011. Age, sex, the cause, the location, the size of rupture, the severity of organ injury, the surgical materials used for repair, the associated morbidity and mortality, and the duration of hospitalization were all evaluated. Results: There were 12 male patients (92.3%) and 1 female patient (7.7%) with an overall mean age of 28.76 years (range: 15-55 years). Blunt trauma was responsible for the injuries in 4 patients (30.8%), while 9 patients (69.2%) had penetrating injuries. The diagnosis was established preoperatively in all patients (100%) via a plain chest X-ray and/or a computed tomography (CT) scan. The location of rupture was on the left side of the diaphragm in 12 patients (92.3%) and on the right side in 1 (7.7%). Isolated post-traumatic diaphragmatic rupture was repaired with interrupted nonabsorbable sutures or polypropylene mesh. Postoperative complications were observed in 2 patients (15.3%). Mortality did not occur in any of our patients. Conclusions: A meticulous physical examination and obtaining a chest X-ray should be the first steps to be taken in patients with suspicious isolated post-traumatic diaphragmatic rupture. In case of uncertainty in diagnosis, advanced modalities such as CT, ultrasonography, and magnetic resonance imaging should be utilized.

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“…Traumatic diaphragmatic rupture is caused by penetrating or blunt traumas to the thoracoabdominal region, [2,3] and the ratio of penetrating traumas to blunt traumas varies geographically. [2,5] In current published series, it was demonstrated that 35-78% of diaphragmatic ruptures were the result of blunt traumas, whereas penetrating traumas accounted for 22-65% of the cases.…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

“…[1,2] One form of TDR in which the stomach herniates into the thoracic cavity was first discovered and defined by Sennertus in 1541 during the autopsy of a person who had been stabbed seven months earlier. [2][3][4] The diagnosis of TDR is often delayed because other clinical conditions such as life-threatening hemorrhagic shock emerge in these cases. [1,2] In this study, patients with TDR that required surgical treatment in our clinic were examined with regard to the time and method of diagnosis, type of surgical treatment, causes of death, and factors that influenced these deaths in order to reveal how to decrease the high mortality rate associated with this condition.…”

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confidence: 99%

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Factors affecting mortality in traumatic diaphragmatic ruptures

Tarladacalisir¹

2014

Turk Gogus Kalp Dama

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Amaç: Bu çalışmada diyafram rüptürü nedeni ile cerrahi uygulanan hastalarda mortaliteyi ekileyen olası faktörler araştırıldı. Ça lış mapla nı:Mayıs 1997 -Mayıs 2009 tarihleri arasında toplam 30 hasta (27 erkek, 3 kadın; ort. yaş 42.6 yıl; dağı-lım 16-88 yıl) diyafram rüptürü nedeni ile kliniğimizde ameliyat edildi. Hastalar mortaliteyi etkileyen olası faktör-ler açısından retrospektif olarak değerlendirildi. Yirmi iki hastaya acil cerrahi girişim ilk yedi günde uygulandı. Diğer altı hasta latent fazda ve iki hasta obstrüktif fazda ameliyat edildi. Bul gu lar: Dokuz hastaya torakotomi, dokuz hastaya laparotomi ve 12 hastaya torakotomi ve laparotomi yapıldı. Sekiz hastaya eksploratif laparotomi ile tanı konuldu. Hastanede kalış süresi ortalama 12 gün (1-50 gün) idi. Sekiz hastada morbidite (%27) görülür iken, yedi hastada (%23) mortalite görüldü. Beş hastada eşlik eden yaralanma bulunamaz iken, 25 hastada eşlik eden yaralanmalar vardı. Bu hastaların 16'sında (%53) eşlik eden yaralanmalar için ek cerrahi girişimler gerekti. İleri yaş (p= 0.020) ve daha uzun süre yoğun bakım ihtiyacı olması (p= 0.020) mortaliteyi negatif yönde etkileyen faktörler olarak bulundu. So nuç:Eşlik eden organ yaralanmaları morbidite ve mortaliteyi etkileyen ana prognostik faktördür. İleri yaş ve travmatik diyafram rüptürüne eşlik eden organ yaralanması olan hastaların mekanik ventilatörden erken ayrılması, agresif tedavi ve yakın takibi, morbidite ve mortaliteyi azaltabilir.Anah tar söz cük ler: Diyafram; mortalite; rüptür; travma.Background:This study aims to investigate possible factors affecting mortality in patients with traumatic diaphragmatic ruptures. Methods: Between May 1997 and May 2009 a total of 30 patients (27 males, 3 females; mean age 42.6 years; range 16 to 88 years) were operated in our clinic with a diagnosis of traumatic diaphragmatic rupture. The patients were evaluated retrospectively in terms of possible factors affecting mortality. Emergency surgery was performed 22 patients within the first seven days. Other two patients were operated in the latent phase and six patients were operated in the obstructive phase. Results: Thoracotomy was performed in nine patients, laparotomy in nine patients and thoracotomy + laparotomy in 12 patients. Eight patients were diagnosed by explorative laparotomy. The mean duration of hospitalization was 12 days (range, 1-50 days). Morbidity was observed in eight patients (27%), while mortality was seen in seven patients (23%). Five patients had no associated pathology, while various associated pathologies were observed in 25 patients. Additional surgical interventions were required for associated pathologies in 16 of these patients (53%). Older age (p=0.020) and need for longer length of stay in the intensive care unit (p=0.020) were found to be negative prognostic factors affecting mortality. Conclusion: Associated organ injuries are the main prognostic factors which affect morbidity and mortality. Early weaning from mechanical ventilation, aggressive treatment and close follow-up of pati...

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A review diaphragmatic injury

Cited by 52 publications

References 20 publications

Descriptive Analysis of Right and Left-sided Traumatic Diaphragmatic Injuries; Case Series from a Single Institution

Descriptive Analysis of Right and Left-sided Traumatic Diaphragmatic Injuries; Case Series from a Single Institution

Original article An extremely rare clinical condition: isolated post-traumatic diaphragmatic injuries

Factors affecting mortality in traumatic diaphragmatic ruptures

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