Leukocytes are not Reliable in Predicting Possible Diaphragmatic Injury in Patients with Penetrating Left Thoracoabdominal Stab Wounds

Abstract

Background The diaphragm is injured in approximately one-third of penetrating left thoracoabdominal stab wounds. Diagnostic laparoscopy or thoracoscopy is performed to reveal the diaphragmatic injury. This study investigated whether leukocytes, leukocyte subgroups, platelets, the neutrophil-to-lymphocyte ratio (NLR), and the thrombocyteto-lymphocyte ratio (PLR) can be used to detect diaphragm injury without the need for diagnostic laparoscopy. Methods Patients hospitalized between January 2010 and January 2020 due to penetrating left thoracoabdominal stab wounds were examined. Laparotomy was performed in patients who had indications for laparotomy, such as hemodynamic instability and peritonitis. Diagnostic laparoscopy was performed to reveal possible diaphragmatic injury in patients who did not require laparotomy after 48h of follow-up. Leukocytes, leukocyte subgroups, platelets, NLR, and PLR were measured both at admission and during follow-up, and the results were compared between patients with and without diaphragm injury during diagnostic laparoscopy. ResultsThe study included 108 patients with penetrating left thoracoabdominal stab wounds that did not require laparotomy after 48h of follow-up. Of these, 102 patients were male (94.44%), and the average age was 27.68 years (range 15-66 years). Diaphragm injury was detected in 31 patients (28.70%) in diagnostic laparoscopy, and the diaphragm was intact in 77 patients (71.30%). In the comparison of patients with and without diaphragmatic injury, no statistically significant difference was found in terms of age, gender, platelets, leukocyte values, NLR, and PLR both at admission and during follow-up. Conclusions Leukocytes, leukocyte subsets, platelets, NLR, and PLR were insufficient in the detection of asymptomatic diaphragmatic injuries caused by penetrating left thoracoabdominal stab wounds.

Is diagnostic laparoscopy necessary in the management of left thoracoabdominal stab wounds?

“…Although some advice a follow-up with leukocyte numbers and indices, a recent study showed the insufficiency of these parameters in the detection of asymptomatic diaphragmatic injuries caused by penetrating left thoracoabdominal stab wounds. [ 23 ]…”

“…[22] Although some advice a follow-up with leukocyte numbers and indices, a recent study showed the insufficiency of these parameters in the detection of asymptomatic diaphragmatic injuries caused by penetrating left thoracoabdominal stab wounds. [23] Despite several reports suggesting the non-operative management of stab wounds, most data were derived from exclusively abdominal injuries. They also suggest the observation of the patient by a single surgeon starting from admission to discharge or to the surgery.…”