BibTex RIS Cite

Traumatic injuries of the diaphragm

Year 2012, Volume: 39 Issue: 2, 257 - 261, 01.06.2012
https://doi.org/10.5798/diclemedj.0921.2012.02.0137

Abstract

Objectives: In this study, patient characteristics, diagnosis and treatment of patients with traumatic injury of the diaphragm, and the outcomes were evaluated. Materials and methods: Between 2002 and 2012, 19 patients were treated for blunt and penetrating diaphragmatic injury at the Thoracic Surgery Clinics of two teaching hospitals. The patients were evaluated retrospectively. Results: The etiology of trauma was traffic accidents in 8 cases, falls from height in three, earthquake-related wounds in two, and stab wounds in six cases (SW). The most frequent complaints and physical findings were dyspnea, chest pain, abdominal distension and the absence of respiratory sounds. The most frequently encountered finding from the chest radiography was disappearance of diaphragmatic shadow, elevation of the diaphragm, and visceral herniation to the thorax. All patients underwent surgery. A left diaphragmatic rupture was diagnosed in 13, and a right diaphragmatic rupture in 6 patients. Fourteen patients had visceral herniation without strangulation. In fourteen patients, the diaphragmatic injury was accompanied by intra-abdominal organ injuries, lung injuries and the other system injuries. In one case, cardiac injury, and in four cases, an isolated diaphragmatic rupture was diagnosed. The most commonly associated organ in diaphragmatic injury was the stomach. In all cases, the diaphragm was repaired by two layers of non-absorbable sutures. The mortality was approximately 5.6%, depending on associated injuries. Conclusion: The prognosis of the blunt and sharp diaphragmatic injuries depends on the severity of the concomitant injuries, and on the problems that may arise due to delays.

References

  • Eren S. Diafragma Yaralanmaları. Turkiye Klinikleri J Surg Med Sci 2007, 3(47):38-42
  • Adegboye VO, Ladipo JK, Adebo OA, Brimmo AI. Dia- phragmatic injuries. Afr J Med Med Sci 2002;31 (2):149- 53.
  • Meyers BF, McCabe CJ. Traumatic diaphragmatic her- nia. Occult marker of serious injury. Ann Surg 1993;218 (1):783-90.
  • Guth AA, Pachter HL, Kim U. Pitfalls in the diagnoses of blunt diaphragmatic injury. Am J Surg 1995;170(3):5-9.
  • Panagiotis NS. Diaphragmatic injuries. In: Shields TW, edi- tor. General thoracic surgery. 6th ed. Philadelphia: Lippin- cott Williams & Wilkins; 2005. p. 1006-14.
  • Çobanoğlu U, Kara V, Yalçınkaya İ ve ark. Traumatic dia- phragmatic ruptures: diagnostic and therapeutic approach- es. Türk Göğüs Kalp Damar Cerrahisi Dergisi 2012; 20 (1): 85-93.
  • Yüksel M, Kalaycı G (eds). Diyafragma Yralanmaları. Gö- ğüs Cerrahisi. İstanbul: Bilmedya Grup, 2001:747-71.
  • Polat KY, Akçay MN, Çapan Y ve ark. Akut Diafragma Yara- lanmaları. Ulusal Travma Dergisi 1995;(1):59-62.
  • Akgün Y, Aban N, Taçyıldız İ, Keleş C, Blunt Diaphragmatic Injuries. Ulusal Travma Dergisi 1996;12(2):15-21.
  • Shah R, Sabanathan S, Mearns AJ, Choudhury AK. Traumatic Rupture of Diaphragm. Ann Thorac Surg 1995;60(3):1444-9.
  • Boulanger BR, Milzman DP, Rosati C, et al. A comparison of right and left blunt traumatic diaphragmatic rupture. J Trauma 1993;35(1): 255-60.
  • Guth AA, Pachter HL, Kim U. Pitfalls in the diagnosis of blunt diaphragmatic injury. Am J Surg 1995; 170(1): 5-9.
  • Chen JC, Wilson SE. Diaphragmatic injuries: rec- ognition and management in sixty-two patients. Am Surg1991;57(12): 810-5.
  • Goh BKP, Wong ASY, Tay KH, et al. Delayed presenta- tion of a patient with a ruptured diaphragm complicated by gastric incarceration and perforation after apparently minor blunt trauma. Can J Emerg Med 2004; 6(4):277-80.
  • Sirbu H, Busch T, Spillner J, et al. Late bilateral diaphrag- matic rupture: challenging diagnostic and surgical repair. Hernia 2005; 9(1): 90-2.
  • Lee WC,Chen PC, Fang JF, et al. Rupture of the diaphragm after blunt trauma. Eur J Surg 1994;160(1): 479-83.
  • Demirel M, İşgör A, Uludağ A. Travmatik Diafragma Rüp- türleri. Ulusal Travma Dergisi 1995; 8(1):102
  • Okur H, Turan C, Bozkurt A ve ark. Çocuklarda Travmatik Diafragma Rüptürleri. Ulusal Travma Dergisi 996; 14(2): 26-9.
  • Hasdemir O, Çetinkunar S, Yalçın E, Gazioğlu D, Soylu S. Minör Künt Travmaya Bağlı Diafragma Rüptürü ve Herni- asyonu- Olgu Sunumu. Ulusal Travma Dergisi 2008; 9(1): 31-4.
  • Thomas P, Moutardier V, Ragni J, Giudicelli R, Fuentes P. Video-assisted repair of a ruptured right hemidiaphragm. Eur J Cardiothorac Surg 1994; 8(3):157-9.
  • Walker WS. Video assisted thoracic surgery (VATS). In: Moghissi K, Thorpe JAC, Ciulli.
  • Mintz Y, Easter DW, Izhar U, Edden Y, Talamini MA, Riv- kind AI. Minimally invasive procedures for diagnosis of traumatic right diaphragmatic tears: a method for correct diagnosis in selected patients. Am Surg 2007; 73(1):388- 92.
  • Ursavaş A, Gözü O, Karadağ M. Travmatik Diafragma Rüptürünün Geç Prezentasyonu. Akciğer Arşivi: 2003; (4): 103-6.
  • Simpson J, Lobo DN, Shah AB, Rowlands BJ. Traumatic diaphragmatic rupture: associated injuries and outcome. Ann R Coll Surg 2000;82(2):97-100.
  • Ülkü R, Özçelik C, Eren Ş, Balcı A, Eren N. Travmatik Diafragma Rüptürleri. Türk Göğüs Kalp Damar Cerrahisi Dergisi 1999;7(1):454-6.
  • Eren Ş, Avcı A, Oruç M, Öztürk B. Transtorasik dikiş iğne- si’ne bağli diafragma rüptürü. Dicle Tıp Dergisi 2010;35(3): 207-10.

Traumatic injuries of the diaphragm

Year 2012, Volume: 39 Issue: 2, 257 - 261, 01.06.2012
https://doi.org/10.5798/diclemedj.0921.2012.02.0137

Abstract

Amaç: Bu çalışmada travmatik diafragma yaralanması olan hastaların özellikleri ve bu hastalarda uygulanan tanı ve tedavi yaklaşımları ve elde edilen sonuçlar değerlendirildi. Gereç ve yöntemler: 2002-2012 tarihleri arasında, iki eğitim hastanesi\'nin Göğüs Cerrahisi kliniklerinde, 19 künt ve penetran diafragma yaralanmalı hasta tedavi edildi. Hastalar retrospektif olarak değerlendirildi. Bulgular: Travma sebebi 8 hastada trafik kazası, 3 hastada yüksekten düşme, 2 hastada depreme bağlı enkaz altında kalma ve 6 hastada kesici delici alet yaralanması (KDAY) idi. Onyedi hasta akut dönemde, 2 hasta kronik dönemde (biri 11 aylık, diğeri 18 aylık travma hikayesi mevcuttu) görüldü. En sık rastlanan şikayetler ve fizik muayene bulguları; dispne, göğüs ağrısı, abdominal distansiyon ve etkilenmiş hemitoraksda solunum seslerinin alınamamasıydı. Akciğer grafisinde ise, en sık diafragma gölgesinin kaybolması, diafragmanın elevasyonu ve toraksa visseral organ herniasyonu bulgularıyla karşılaşıldı. Tüm hastalar operasyona alındılar. Onüç olguda sol, 6 olguda sağ diafragma rüptürü saptandı. Ondört olguda toraksa herniasyon vardı, bir olguda strangülasyon tespit edildi. On dört olguda diafragma yaralanmasına; intraabdominal organ yaralanmaları, akciğer yaralanmaları ve diğer sistem yaralanmaları da eşlik ediyordu. Bir olguda kalp yaralanması ve dört olguda ise, izole diafragma rüptürü saptandı. Künt ve keskin diafragma yaralanmasına en sık eşlik eden organ mide idi. Tüm olgularda, diafragma nonabsorbable sütürlerle iki kat üzerinden tamir edildi. Mortalite oranımız eşlik eden travmalara bağlı olarak %5.6 idi. Sonuç: Künt ve penetran diafragma yaralanmalarında prognoz, eşlik eden yaralanmaların ciddiyeti ve geç başvurudan doğabilecek problemlere bağlıdır.

References

  • Eren S. Diafragma Yaralanmaları. Turkiye Klinikleri J Surg Med Sci 2007, 3(47):38-42
  • Adegboye VO, Ladipo JK, Adebo OA, Brimmo AI. Dia- phragmatic injuries. Afr J Med Med Sci 2002;31 (2):149- 53.
  • Meyers BF, McCabe CJ. Traumatic diaphragmatic her- nia. Occult marker of serious injury. Ann Surg 1993;218 (1):783-90.
  • Guth AA, Pachter HL, Kim U. Pitfalls in the diagnoses of blunt diaphragmatic injury. Am J Surg 1995;170(3):5-9.
  • Panagiotis NS. Diaphragmatic injuries. In: Shields TW, edi- tor. General thoracic surgery. 6th ed. Philadelphia: Lippin- cott Williams & Wilkins; 2005. p. 1006-14.
  • Çobanoğlu U, Kara V, Yalçınkaya İ ve ark. Traumatic dia- phragmatic ruptures: diagnostic and therapeutic approach- es. Türk Göğüs Kalp Damar Cerrahisi Dergisi 2012; 20 (1): 85-93.
  • Yüksel M, Kalaycı G (eds). Diyafragma Yralanmaları. Gö- ğüs Cerrahisi. İstanbul: Bilmedya Grup, 2001:747-71.
  • Polat KY, Akçay MN, Çapan Y ve ark. Akut Diafragma Yara- lanmaları. Ulusal Travma Dergisi 1995;(1):59-62.
  • Akgün Y, Aban N, Taçyıldız İ, Keleş C, Blunt Diaphragmatic Injuries. Ulusal Travma Dergisi 1996;12(2):15-21.
  • Shah R, Sabanathan S, Mearns AJ, Choudhury AK. Traumatic Rupture of Diaphragm. Ann Thorac Surg 1995;60(3):1444-9.
  • Boulanger BR, Milzman DP, Rosati C, et al. A comparison of right and left blunt traumatic diaphragmatic rupture. J Trauma 1993;35(1): 255-60.
  • Guth AA, Pachter HL, Kim U. Pitfalls in the diagnosis of blunt diaphragmatic injury. Am J Surg 1995; 170(1): 5-9.
  • Chen JC, Wilson SE. Diaphragmatic injuries: rec- ognition and management in sixty-two patients. Am Surg1991;57(12): 810-5.
  • Goh BKP, Wong ASY, Tay KH, et al. Delayed presenta- tion of a patient with a ruptured diaphragm complicated by gastric incarceration and perforation after apparently minor blunt trauma. Can J Emerg Med 2004; 6(4):277-80.
  • Sirbu H, Busch T, Spillner J, et al. Late bilateral diaphrag- matic rupture: challenging diagnostic and surgical repair. Hernia 2005; 9(1): 90-2.
  • Lee WC,Chen PC, Fang JF, et al. Rupture of the diaphragm after blunt trauma. Eur J Surg 1994;160(1): 479-83.
  • Demirel M, İşgör A, Uludağ A. Travmatik Diafragma Rüp- türleri. Ulusal Travma Dergisi 1995; 8(1):102
  • Okur H, Turan C, Bozkurt A ve ark. Çocuklarda Travmatik Diafragma Rüptürleri. Ulusal Travma Dergisi 996; 14(2): 26-9.
  • Hasdemir O, Çetinkunar S, Yalçın E, Gazioğlu D, Soylu S. Minör Künt Travmaya Bağlı Diafragma Rüptürü ve Herni- asyonu- Olgu Sunumu. Ulusal Travma Dergisi 2008; 9(1): 31-4.
  • Thomas P, Moutardier V, Ragni J, Giudicelli R, Fuentes P. Video-assisted repair of a ruptured right hemidiaphragm. Eur J Cardiothorac Surg 1994; 8(3):157-9.
  • Walker WS. Video assisted thoracic surgery (VATS). In: Moghissi K, Thorpe JAC, Ciulli.
  • Mintz Y, Easter DW, Izhar U, Edden Y, Talamini MA, Riv- kind AI. Minimally invasive procedures for diagnosis of traumatic right diaphragmatic tears: a method for correct diagnosis in selected patients. Am Surg 2007; 73(1):388- 92.
  • Ursavaş A, Gözü O, Karadağ M. Travmatik Diafragma Rüptürünün Geç Prezentasyonu. Akciğer Arşivi: 2003; (4): 103-6.
  • Simpson J, Lobo DN, Shah AB, Rowlands BJ. Traumatic diaphragmatic rupture: associated injuries and outcome. Ann R Coll Surg 2000;82(2):97-100.
  • Ülkü R, Özçelik C, Eren Ş, Balcı A, Eren N. Travmatik Diafragma Rüptürleri. Türk Göğüs Kalp Damar Cerrahisi Dergisi 1999;7(1):454-6.
  • Eren Ş, Avcı A, Oruç M, Öztürk B. Transtorasik dikiş iğne- si’ne bağli diafragma rüptürü. Dicle Tıp Dergisi 2010;35(3): 207-10.
There are 26 citations in total.

Details

Primary Language Turkish
Journal Section Research Articles
Authors

Abidin Şehitoğulları This is me

Fuat Sayir This is me

Ali Kahraman This is me

Reşit Öncü This is me

Lokman Soyoral This is me

Publication Date June 1, 2012
Submission Date March 2, 2015
Published in Issue Year 2012 Volume: 39 Issue: 2

Cite

APA Şehitoğulları, A., Sayir, F., Kahraman, A., Öncü, R., et al. (2012). Traumatic injuries of the diaphragm. Dicle Tıp Dergisi, 39(2), 257-261. https://doi.org/10.5798/diclemedj.0921.2012.02.0137
AMA Şehitoğulları A, Sayir F, Kahraman A, Öncü R, Soyoral L. Traumatic injuries of the diaphragm. diclemedj. June 2012;39(2):257-261. doi:10.5798/diclemedj.0921.2012.02.0137
Chicago Şehitoğulları, Abidin, Fuat Sayir, Ali Kahraman, Reşit Öncü, and Lokman Soyoral. “Traumatic Injuries of the Diaphragm”. Dicle Tıp Dergisi 39, no. 2 (June 2012): 257-61. https://doi.org/10.5798/diclemedj.0921.2012.02.0137.
EndNote Şehitoğulları A, Sayir F, Kahraman A, Öncü R, Soyoral L (June 1, 2012) Traumatic injuries of the diaphragm. Dicle Tıp Dergisi 39 2 257–261.
IEEE A. Şehitoğulları, F. Sayir, A. Kahraman, R. Öncü, and L. Soyoral, “Traumatic injuries of the diaphragm”, diclemedj, vol. 39, no. 2, pp. 257–261, 2012, doi: 10.5798/diclemedj.0921.2012.02.0137.
ISNAD Şehitoğulları, Abidin et al. “Traumatic Injuries of the Diaphragm”. Dicle Tıp Dergisi 39/2 (June 2012), 257-261. https://doi.org/10.5798/diclemedj.0921.2012.02.0137.
JAMA Şehitoğulları A, Sayir F, Kahraman A, Öncü R, Soyoral L. Traumatic injuries of the diaphragm. diclemedj. 2012;39:257–261.
MLA Şehitoğulları, Abidin et al. “Traumatic Injuries of the Diaphragm”. Dicle Tıp Dergisi, vol. 39, no. 2, 2012, pp. 257-61, doi:10.5798/diclemedj.0921.2012.02.0137.
Vancouver Şehitoğulları A, Sayir F, Kahraman A, Öncü R, Soyoral L. Traumatic injuries of the diaphragm. diclemedj. 2012;39(2):257-61.