Diyafragma Yaralanmaları: 45 Olguluk Deneyim

Öz

Amaç: Diyafragmatik yaralanmalara karar verilirken, yaralanma mekanizması göz önünde bulundurulmalıdır. Rüptür en sık kesici-delici yaralanma nedeniyle ve sol krusa lokalizedir. Öte yandan, gözden kaçırılmış bir rüptür, fıtıklaşmış intraabdominal organların strangülasyonu ve solunumda kısıtlanmaya neden olabilir. Çalışmanın amacı üçüncü basamak bir hastanedeki diyafragma yaralanması olgularının mercek altına alınarak yaralanma mekanizmaları, hastaların cerrahi yönetimi ve tedavi sonuçlarının gösterilmesidir.Gereç ve Yöntemler: Ocak 2008 ve Nisan 2019 arasında cerrahi onarım yapılan diyafragmatik yaralanması olan hastalar analiz edildi. Hastalar yaralanma mekanizmasına göre üç gruba ayrıldı; akut travma, travma sonrası kronik fıtık ve iyatrojenik laserasyonlar.Bulgular: Çalışmadaki 45 hastanın onarımdaki genel yaş ortalaması 43±18 yıldı. Medyan hastanede kalış süreleri 8 gün , takip süresi 7 aydı . On hastada %22,2 yaralanma sağda, 31 hastada %68,9 solda, 4 hastada ise %8,9 bilateraldi. Yirmi bir hastaya %46,7 travmadan sonra gelişen akut diyafragmatik fıtık için primer onarım yapıldı. On hastaya %22,2 aynı ameliyatta iyatrojenik yaralanma için primer onarım yapıldı. On dört hastaya %31,1 travma sonrası gelişen kronik diyafragma hernisi nedeniyle onarım yapıldı; kronik hernisi olan 8 hastanın %57,1 onarımı prostatik mesh ile yapılırken, 6 hastanın %42,9 kronik defekti primer onarım ile kapatıldı.Sonuç: Travma sonrası diyafragma rüptürünün erken teşhisini koymak için yüksek bir şüphe indeksi gereklidir. Künt travmaya bağlı diyafram hasarı, en sık olarak yüksekten düşme sonrası gelişmiştir. Kronik diyafram hasarının en sık nedeni de yine bu yüksekten düşme grubuydu

Anahtar Kelimeler

• Diyafram yaralanması, Diyafram rüptürü, Diyafram laserasyonu, Travma

Diaphragm Injuries: A 45-Case Experience

Abstract

Objective: The mechanism of injury should be considered when deciding on diaphragmatic injuries. Rupture is most commonly due to penetrating injury and localized to the left crus. A missed rupture, on the other hand, may result in strangulation of herniated intra-abdominal viscera as well as respiratory compromise. The aim of this study was to scrutinize the diaphragmatic injury cases in a tertiary hospital and to show the mechanisms of injury, surgical management and treatment outcomes of the patients.Material and Methods: Diaphragmatic injury patients who underwent surgical repair between January 2008 and April 2019 were analyzed. The patients were divided into three groups according to the mechanism of injury as acute trauma, post-traumatic chronic hernia and iatrogenic laceration.Results: There were 45 patients and the overall mean patient age at repair was 43±18 years. The median length of hospital stay was 8 days 6-16 days and median follow-up was 7 months 1-18 months . The injury was right-sided in 10 patients 22.2% , left-sided in 31 patients 68.9% and bilateral in 4 patients 8.9% . Twenty-one patients 46.7% underwent primary repair for acute diaphragmatic hernia after trauma. Ten patients 22.2% underwent primary repair for iatrogenic injury within the same operative session. Fourteen patients 31.1% underwent repair for chronic diaphragmatic hernia after trauma; 8 patients with chronic hernia 57.1% had their repair with a prosthetic mesh and 6 patients 42.9% had their chronic defect closed with primary repair.Conclusion: A high index of suspicion is needed in order to establish an early diagnosis of diaphragmatic rupture after trauma. Blunt trauma-related diaphragm injury most commonly developed after a fall from height. The most common cause of chronic diaphragmatic damage was again from this fall-from-height group

Keywords

• Diaphragm injury, Diaphragm rupture, Diaphragm laceration, Trauma

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