Acute traumatic diaphragmatic ruptures: A retrospective study of 48 cases

Dirican, Abuzer; Yılmaz, Mehmet; Ünal, Bülent; Pişkin, Turgut; Ersan, Veysel; Yılmaz, Sezai

doi:10.1007/s00595-010-4518-3

Cited by 24 publications

(32 citation statements)

References 15 publications

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“…Mortality during the early period is usually caused by coexisting injuries, not by the diaphragmatic rupture itself. Mortality rates range from 1% to 28% [13]. Contrary to the literature, the cases that were complicated in our series were largely those diagnosed late and with a penetrating trauma.…”

Section: Discussioncontrasting

confidence: 63%

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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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Section: Discussioncontrasting

confidence: 63%

“…A diagnosis can be established after visualizing herniated abdominal organs in the thoracic cavity. Spiral reconstruction of CT images in the coronal and sagittal plane is an easy and useful way to establish the definitive diagnosis of a diaphragmatic rupture [13]. Chest X-ray was performed as a priority for the cases in our study.…”

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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“…Larger ruptures are more likely to result inintra-abdominal organs herniating into the thoraxin the acute phase, and the diagnosis is easier both on the left and on the right due to the possibility of following the lesion trajectory and the observation of contiguous lesions 6,9 .…”

Section: Introductionmentioning

confidence: 99%

“…Thoracoscopy has been proposed as a safe method for evaluating the diaphragm when the diagnosis has not been confirmed and laparotomy is not necessary, with sensitivity and specificity close to 100%, the limiting factors being the presence of hemodynamic instability and the need for general anesthesia 9 .…”

Section: Introductionmentioning

confidence: 99%

Análise retrospectiva de 103 casos de lesão diafragmática operados em um centro de trauma

Cardoso

Gonçalves

Machado

et al. 2017

Rev. Col. Bras. Cir.

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RESUMO Objetivo: analisar os fatores associados ao óbito em pacientes com lesão diafragmática atendidos em hospital de referência para o trauma. Métodos: estudo retrospectivo de pacientes com lesão do diafragma atendidos no Hospital Risoleta Tolentino Neves da Universidade Federal de Minas Gerais entre janeiro de 2010 e dezembro de 2014. Foi utilizado o Banco de Registros de Trauma Collector® (MD, USA). Utilizaram-se dados demográficos, localização da lesão diafragmática, lesões associadas de outros órgãos, número de lesões associadas, tipo de abordagem terapêutica, complicações e o escore de gravidade Injury Severity Score (ISS). A variável de interesse foi a ocorrência de óbito. Resultados: foram identificados 103 pacientes e a incidência de óbito foi de 16,5%. Lesões penetrantes ocorreram em 98% dos pacientes. Em análise univariada a mortalidade foi maior em pacientes cujo tratamento foi não operatório, sem rafia (p=0,023), e menor em pacientes submetidos à rafia diafragmática (p<0,001). O aumento do número de lesões associou-se ao aumento da incidência de óbitos (p=0,048). Em análise multivariada, ISS>24 (OR=4,0; p=0,029) e rafia do diafragma (OR=0,76; p<0,001) associaram-se à mortalidade. Conclusão: os achados indicam que a ruptura traumática do diafragma raramente se apresenta como lesão isolada, estando associada frequentemente à lesão de outros órgãos, especialmente fígado e vísceras ocas. Pode-se afirmar que a mortalidade foi mais elevada entre aqueles com ISS>24.

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“…In close connection with increasing trafic and car accidents -phenomenon of modern life-large series of diaphragmatic ruptures [1][2][3][4], including even right sided one [5][6][7][8] were published in world literature.…”

Section: Introductionmentioning

confidence: 99%

Risk Factores of Delayed Diaphragmatic Ruptures

Kotsis¹,

Kostic²,

Vadász³

2017

IJRRT

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In contrast to the world thoracic literature, less attention has been payed to blunt diaphragmatic ruptures in hungarian surgical literature.Based on 12 cases of blunt traumatic diaphragmatic rupture at Thoracic Surgical Clinic (1981-2001, circumstances of late recognition is evaluated. In majority of patients history of thoracic and/or abdominal truma has been totaly forgotten, resulting fals diagnosis of tension pneumothorax in one. In 3 others the diaphragmatic tear was missed during the previous laparotomy in one or considered as a hiatal hernia in the second and a really recurrent hernia was confused with a posttraumatic diaphragmatic palsy in the third. A subgroup of this entity, the two-steps ruture of one patient, may considered as a life-threatening urgency, when early approach is mandatory. In this series for diaphragmatic reconstruction in dominantly left-sided rutures (10) a similar sided postreolateral thoracotomy were used, and right-sided in the remaing 2, buttressed in only one, without mortality and recurrence.The delay of diagnosis may considered as the primordial factor of mortality. Even in long-lasting occult cases all efforts are necessary to solve the diagnostic dilemma, befor fatal visceral strangulation, befor development of feco-pneumothorax, gastric necrosis or tension pneumothorax. Suspition of the thoracoabdominal trauma may consisered as an important factor of true diagnosis and for pervention of iatrogenic surgical events. so transthoracic approach for diaphragmatic repair seems to be the best approach [16]. This series like other lage series reflects that delayed recognition of diaphragmatic rupture [17,18] may be considered as primordial factor of mortality. Keywords:

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Acute traumatic diaphragmatic ruptures: A retrospective study of 48 cases

Abstract: The outcome of the patients is associated with presence of hemorrhagic shock, a high injury severity score, and additional organ injury.

Cited by 24 publications

References 15 publications

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

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

Análise retrospectiva de 103 casos de lesão diafragmática operados em um centro de trauma

Risk Factores of Delayed Diaphragmatic Ruptures

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