Sixty-three cases of traumatic injury of the diaphragm

Sukul, D.M.K.S.Kaulesar; Kats, E.; Johannes, E.J.

doi:10.1016/0020-1383(91)90011-3

Cited by 38 publications

(20 citation statements)

References 7 publications

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“…2018;33(1): [49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66] of the included studies reported the need to open the second cavity, so when opting for the thoracic approach, the need for abdominal cavity opening appears to have been greater than when the option was for the abdominal approach, but due to the small number of cases where it was possible to collect these data, the confidence interval was very wide, making this difference not significant. Perhaps if more studies had shown this data we could have found significant difference.…”

Section: ■ Discussionmentioning

confidence: 99%

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Thoracotomy compared to laparotomy in the traumatic diaphragmatic hernia. Systematic review and proportional methanalysis

Silva

Catâneo

2018

Acta Cir. Bras.

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Purpose: To evaluate the most used approach to treat traumatic diaphragmatic ruptures, and in which one the requirement to assess the second cavity is more frequent. Methods: Systematic review, observational studies. Outcomes: moment of approach, most commonly via addressed and the requirement to open the other cavity. Bases searched: Lilacs, Pubmed, Embase, Clinicaltrials.gov and Web of Science. Statistical analysis: StatsDirect 3.0.121 software. Results: Sixty eight studies (2023 participants) were included. Approach in acute phase was performed four times more than in chronic phase. Approach: abdominal 65% (IC 95% 63-67%), thoracic 23% (IC 95% 21-24%), abdominal in the acute phase 75% (IC 95% 71-78%), and chronic 24% (IC 95% 19-29%), thoracic in the acute phase 12% (IC 95% 10-14%) and chronic 69% (IC 95% 63-74%). Thorax opening in the abdominal approach: 10% (95% CI 8-14%). Abdomen opening in the thoracic approach: 15% (95% CI 7-24%). Conclusions: The most common approach was the abdominal. The approach in the acute phase was more common. In the acute phase the abdominal approach is more frequent than the thoracic approach. In the chronic phase the thoracic approach is more frequent than the abdominal one. The requirement to open the second cavity was similar in both approaches.

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Section: ■ Discussionmentioning

confidence: 99%

“…2018;33(1): [49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66] 4-The most used approach in the chronic phase.…”

Section: ■ Introductionmentioning

confidence: 99%

Thoracotomy compared to laparotomy in the traumatic diaphragmatic hernia. Systematic review and proportional methanalysis

Silva

Catâneo

2018

Acta Cir. Bras.

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“…Although there are no specific symptoms leading directly to the diagnosis of diaphragmatic rupture, there are symptoms that indicate the possibility, such as abdominal pain, shortness of breath, chest pain, and hematuria. Signs of diaphragmatic rupture can also include abdominal tenderness and decreased breathing sounds [8]. Accompanying injuries to other organs occurred in 94% of cases, including 72~79% of cases with intra-abdominal injuries and 81% with extra-abdominal injuries.…”

Section: Discussionmentioning

confidence: 99%

Management of Patients with Traumatic Rupture of the Diaphragm

Hwang

Kim

Byun

2011

Korean J Thorac Cardiovasc Surg

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BackgroundTraumatic rupture of the diaphragm is an unusual type of trauma. In addition, it is difficult to diagnose because it can be accompanied by injuries to other organs. If it is not detected early, the mortality rate can increase due to serious complications. Diaphragmatic rupture is an important indicator of the severity of the trauma. The aim of this study was to investigate the factors affecting the incidence of complications and mortality in patients who had surgery to treat traumatic rupture of the diaphragm.Materials and MethodsThe subjects were patients who had undergone a diaphragmatic rupture by blunt trauma or stab wounds except patients who were transferred to other hospitals within 3 days of hospitalization, from January 2000 to December 2007. This study was a retrospective study. 43 patients were hospitalized, and 40 patients were included during the study period. Among them, 28 were male, 12 were female, and the average age was 42 (from 18 to 80). Outcome predictive factors including hypoxia, ventilator application days, revised trauma score (RTS), injury severity score (ISS), age, herniated organs, complications, and the mortality rate were investigated.ResultsCauses of trauma included motor vehicle crashes for 20 patients (50%), falls for 10 (25%), stab wounds for 8 (20%), and agricultural machinery accidents for 2 (5%). Most of the patients (36 patients; 90%) had wound sites on the left. Diagnosis was performed within 12 hours for most patients. The diaphragmatic rupture was diagnosed preoperatively in 27 patients (70%) and in 12 patients (30%) during other surgeries. For surgical treatment, thoracotomy was performed in 14 patients (35%), laparotomy in 11 (27.5%), and a surgery combining thoracotomy and laparotomy in 15 patients (37.5%). Herniated organs in the thoracic cavity included the stomach for 23 patients (57.5%), the omentum for 15 patients (37.5%), the colon for 10 patients (25%), and the spleen for 6 patients (15%). Accompanying surgeries included splenectomy for 13 patients (32.5%), lung suture for 6 patients (15%), and liver suture for 5 patients (12.5%). The average hospital stay was 47.80±56.72 days, and the period of ventilation was 3.90±5.8 days. The average ISS was 35.90±16.81 (11~75), and the average RTS was 6.46±1.88 (1.02~7.84). The mortality rate was 17.5% (7 patients). Factors affecting complications were stomach hernia and age. Factors affecting the mortality rate were ISS and RTS.ConclusionThere are no typical symptoms of the traumatic rupture of the diaphragm by blunt trauma. Nor are there any special methods of diagnosis; in fact, it is difficult to diagnose because it accompanies injuries to other organs. Stab wounds are also not easy to diagnose, though they are relatively easy to diagnose compared to blunt trauma because the accompanying injuries are more limited. Suture of the diaphragm can be performed through the chest, the abdomen, or the thoracoabdomen. These surgical methods are chosen based on accompanying organ injuries. When there are many organ injuri...

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“…Between 20–50% of patients who are later found to have a traumatic diaphragmatic injury have their initial trauma chest radiographs described as normal 9. Diagnostic yield is increased by serial radiographs as a diaphragmatic defect itself will not show up on a plain chest X-ray and it is often only when the intrathoracic and abdominal pressures equalise that abdominal viscera herniate through the defect 11. CT scanning has traditionally been regarded as insensitive for the diagnosis of diaphragmatic injury owing to movement artefact, but the advent of faster multislice CT scanners can image the diaphragm in a single breath hold and this has been credited with increasing the sensitivity of TDI by CT scanning12 and numerous CT signs have been described 2.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopically assisted repair of an acute traumatic diaphragmatic hernia

Safdar¹,

Slater

Garner

2013

BMJ Case Reports

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SUMMARYA 60-year-old man with chronic obstructive pulmonary disease and a heavy smoker and drinker presented to the emergency department with left-sided thoracoabdominal pain after falling down the stairs. Initial clinical findings were left-sided chest tenderness with no clinical evidence of subcutaneous emphysema. Twenty-four hours later the patient's respiratory distress increased-repeat chest X-ray showed a left gastrothorax indicative of a ruptured left hemi diaphragm. Diagnostic laparoscopy in the supine position via an umbilical port confirmed the presence of the stomach, spleen and splenic flexure of the colon in the left chest. Laparoscopic reduction of the stomach and colon was performed, but a small upper midline incision was required to reduce the spleen without injury. The diaphragmatic tear was repaired by direct open suture. The patient required a brief period of postoperative ventilation via a tracheostomy. The patient remained well at a 3-month follow-up visit. BACKGROUND

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Sixty-three cases of traumatic injury of the diaphragm

Cited by 38 publications

References 7 publications

Thoracotomy compared to laparotomy in the traumatic diaphragmatic hernia. Systematic review and proportional methanalysis

Thoracotomy compared to laparotomy in the traumatic diaphragmatic hernia. Systematic review and proportional methanalysis

Management of Patients with Traumatic Rupture of the Diaphragm

Laparoscopically assisted repair of an acute traumatic diaphragmatic hernia

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