Systemic inflammatory response syndrome following laparoscopic repair of diaphragmatic injury: A case report

Abstract

Trauma is a major cause of morbidity and mortality in the younger age group. Though diagnostic laparoscopy has been attempted in trauma earlier, with the advance in minimal access techniques, there is an increasing attempt at advancing the indications for laparoscopy in the setting of trauma. Though there are reports and studies on the successful use of laparoscopy in the setting of abdominal trauma, it is essential to remember that laparoscopy in trauma is associated with risks inherent in the procedure itself and also with higher incidence of missed injuries if used as a diagnostic tool.

Missed injury and complication after laparoscopy in trauma: Is the procedure still preferable?

“…In the recent publication by Umman, the unfavourable outcome can also be seen. [ 1 ] The suggestion that “the best applications may be in haemodynamically stable patients with stab wounds or tangential wounds to the anterior abdominal wall”[ 1 2 ] should be revised. Although the complication due to the procedure might not be highly prevalent and might relate to the specific difficulty in specific case and experience of the practitioner, the very high rate of missed injury might be a very big problem.…”

“…Although the complication due to the procedure might not be highly prevalent and might relate to the specific difficulty in specific case and experience of the practitioner, the very high rate of missed injury might be a very big problem. Based on the data that “approximately 5% of patients with blunt trauma and 10% to 15% of patients with penetrating injuries to the chest and abdomen have diaphragmatic injuries”[ 1 3 ] and “as a diagnostic tool, laparoscopy had a 41% to 77% missed injury rate per patient,”[ 1 4 ] it can be estimated that missed diaphragmatic injuries can be seen in 2.1% to 3.9% of patients with blunt trauma and 4.1% to 11.6% of patients with penetrating injuries to the chest and abdomen if diagnostic laparoscopy is used. For sure, the high rate of missed injury means repeated abdominal exploration later on, and medical litigation might be another issue that should be kept in mind.…”