BibTex RIS Kaynak Göster

Retrospective Analysis of Twenty-four Patients with Traumatic Penetrating Diaphragmatic Ruptures

Yıl 2016, Cilt: 5 Sayı: 1, 52 - 56, 01.01.2016
https://doi.org/10.5505/abantmedj.2016.68916

Öz

OBJECTIVE: Traumatic penetrating diaphragmatic rupture TPDR is a rare condition that can be hardly diagnosed clinically and radiologically and associated with high morbidity and mortality. The purpose of this study was to evaluate our experience of 6 years on TPDR of our retrospective analysis with the literature.METHODS: Between December 2008 and February 2015, 24 patients of 3 women and 21 men with TPDR were retrospectively analysed. Age, gender, location and diameter of injury, accompanied other organ injuries, surgical procedures, length of hospital stay and mortality were evaluated.RESULTS: A total of 24 patients, 21 women and 3 men. The mean age was 36.6±7.2 19-66 years. There were seventeen patients with penetrating stab wounds, 2 with gunshot wounds and 4 with iatrogenic diaphragm injury. The injury was settled at left on 20 patients, at right on 3 and bilaterally on 1 patient. The injury size was 2.0±0.8 0.5-10 cm. The 3 patients were operated laparoscopically, the remainder 21 with open procedure. Concomitant organs injuries; 8 spleen, 3 liver, 2 lung, 5 stomach, 3 transverse colon, 2 sigmoid colon, 5 small intestine, 1 pancreas and 1 aorta. Length of hospital stay was 10.2±3.8 1-36 days. Because of accompanying injury and hemorrhagic shock 1 patient intraoperatively and 1 postoperatively died. Total mortality was 2.CONCLUSION: At emergency TPDR in cases of undiagnosed with clinical and radiological conditions, presence of the diaphragm injuries with the thorax and abdominal organ injuries should be kept in mind and routine exploration should not be neglected by the surgeon.

Kaynakça

  • Reber PU, Schmied B, Seiler CA, Baer HU, Patel AG, Büchler MW. Missed diaphragmatic injuries and their long-term sequel. J Trauma 1998; 44: 183-8.
  • Koda M, Ueki M, Maeda N, Murawaki Y. Diaphragmatic perforation and hernia after hepatic radiofrequency ablation. AJR Am J Roentgenol 2003; 180: 1561-2.
  • Chughtai T, Ali S, Sharkey P, Lins M, Rizoli S. Update on managing diaphragmatic rupture in blunt truma. A review of 208 consecutive cases. Can J Surg 2009; 52: 177-81.
  • Boulanger BR, Milzman DP, Rosati C, Rodriguez A. A comparison of right and left blunt trumatic diaphragmatic rupture. J Trauma 1993; 35: 255-60.
  • Cagrici U. Diyafragma ve frenik sinir yarlanmaları. In: Yüksel M, Cetin G, editors. Toraks travmaları. 1. Baskı, İstanbul: Turgut Yayıncılık, 2003: 185-204.
  • Carter Bn, Gıuseffı J, Felson B. Traumatic diaphragmatic hernia. Am J Roentgenol Radium Ther 1951; 65: 56-72..
  • Zeybek N EM, Gözübüyük A, Peker Y, Genc O, Oner K, et al. Diaphragmatic injuries: an analysis of 36 cases. Turkish Journal of Thoracic and Cardiovaskular surgery 2007; 15: 221-5.
  • Mihos P, Potaris K, Gakidis J, Paraskevopoulos J, Varvatsoulis P, Gougoutas B, Papadakis G, Lapidakis E. Traumatic rupture of the diaphragm: experience with 65 patients. Injury 2003; 34: 169-72.
  • Haciibrahimoglu G, Solak O, Olcmen A, Bedirhan MA, Solmazer N, Gurses A. Management of traumatic diaphragmatic rupture. Surg Today 2004; 34: 111-4.
  • Düzgün AP, Ozmen MM, Saylam B, Coşkun F. Factors influencing mortality in traumatic ruptures of diaphragm. Turk J Trauma Emerg Surg 2008; 14: 132-8.
  • Hanna WC, Ferri LE, Fata P, Razek T, Mulder DS. The current status of traumatic diaphragmatic injury: lessons learned from 105 patients over 13 years. Ann Thorac Surg, 2008; 85: 1044-8.
  • Bostancı H, Dikmen K, Sahin TT. Travmatik Diyafram Rüptürleri: Yirmi Hastanın Retrospektif Analizi. Gazi Medical Journal, 2012, 23.2.
  • Meyers BF, McCabe CJ. Traumatic diaphragmatic hernia. Occult marker of serious injury. Ann Surg 1993; 218: 783- 90.
  • Vatansev C, Aksoy F, Tekin S, Tekin A, Belviranli M, Kaynak A. Karın travmasında diyafragma rüptürü. Ulus Travma Acil Cerrahi Derg 2003; 9: 285-90.
  • Rubikas R, Diaphragmatic injuries. Eur J Cardiothorac Surg 2001. 20: 53-7.
  • Turhan K, Makay O, Cakan A, Samancilar O, Firat O, Icoz G, Cagirici U. Traumatic diaphragmatic rupture: look to see. Eur J Cardiothorac Surg 2008; 33: 1082-5.
  • Symbas PN, Vlasis-Hale SE, Picone AL, Hatcher CR Jr. Missiles in the heart. Ann Thorac Surg 1989; 48: 192-4.

Travmatik Penetran Diyafram Rüptürlü Yirmidört Hastanın Retrospektif Analizi

Yıl 2016, Cilt: 5 Sayı: 1, 52 - 56, 01.01.2016
https://doi.org/10.5505/abantmedj.2016.68916

Öz

AMAÇ: Travmatik penetran diyafram rüptürleri TPDR klinik ve radyolojik olarak tanısı zor konulabilen yüksek morbidite ve mortalite ile seyredebilen nadir bir durumdur. Bu çalışmanın amacı, 6 yıllık vakalarımızın retrospektif analizinden çıkan verilerle travmatik penetran diyafram rüptürleri konusunda deneyimlerimizi literatür eşliğinde değerlendirmektir. YÖNTEMLER: Çalışmamızda Aralık 2008 ile Şubat 2015 tarihleri arasında kliniğimizce TPDR tanısı ile tedavi edilen 3’ü kadın, 21’i erkek toplam 24 hastanın verileri retrospektif olarak tarandı. Hastaların yaş, cinsiyet, yaralanmanın yeri ve çapı, eşlik eden diğer organ yaralanmaları, uygulanan cerrahi prosedürler, hastanede kalış süresi ve mortalite yönünden değerlendirildi.BULGULAR: Toplam 24 hastanın 21’i erkek ve 3’ü kadındı. Yaş ortalaması 36,6±7,2 19-66 idi. On yedi hastada kesici delici alet yaralanması, 2 hastada ateşli silah yaralanması ve 4 hastada iyatrojenik penetran diafram yaralanması mevcuttu. Yaralanmaların yerleşim yeri 20 hastada solda, 3 hastada ise sağda ve 1 hastada bilateraldi. Yaralanma boyutu ise 2.0±0.8 0,5-10 cm idi. Operasyona alınan hastaların 3’ü laparaskopik olarak geriye kalan 21’i açık olarak ameliyat edildi. Eşlik eden diğer organ yaralanmaları açısından; 8 dalak, 3 karaciğer, 2 akciğer, 5 mide, 3 transvers kolon, 2 sigmoid kolon, 5 ince barsak, 2 pankreas ve 1 aort yaralanması mevcuttu. Hastanede kalış süresi ortalama 10.2±3.8 1-36 gündü. Eşlik eden organ yaralanmaları ve hemorajik şok nedeniyle 1 hasta intraoperatif diğeri postoperatif dönemde exitus oldu. Toplam mortalite sayısı 2 idi.SONUÇ: Acil şartlarda TPDR tanısı klinik ve radyolojik olarak konulamayan vakalarda operasyonda toraks ve karın boşluğundaki organ yaralanmaları ile birlikte diyafram yaralanmaları da akılda bulundurulmalı ve rutin eksplorasyonu cerrahlar tarafından ihmal edilmemelidir.

Kaynakça

  • Reber PU, Schmied B, Seiler CA, Baer HU, Patel AG, Büchler MW. Missed diaphragmatic injuries and their long-term sequel. J Trauma 1998; 44: 183-8.
  • Koda M, Ueki M, Maeda N, Murawaki Y. Diaphragmatic perforation and hernia after hepatic radiofrequency ablation. AJR Am J Roentgenol 2003; 180: 1561-2.
  • Chughtai T, Ali S, Sharkey P, Lins M, Rizoli S. Update on managing diaphragmatic rupture in blunt truma. A review of 208 consecutive cases. Can J Surg 2009; 52: 177-81.
  • Boulanger BR, Milzman DP, Rosati C, Rodriguez A. A comparison of right and left blunt trumatic diaphragmatic rupture. J Trauma 1993; 35: 255-60.
  • Cagrici U. Diyafragma ve frenik sinir yarlanmaları. In: Yüksel M, Cetin G, editors. Toraks travmaları. 1. Baskı, İstanbul: Turgut Yayıncılık, 2003: 185-204.
  • Carter Bn, Gıuseffı J, Felson B. Traumatic diaphragmatic hernia. Am J Roentgenol Radium Ther 1951; 65: 56-72..
  • Zeybek N EM, Gözübüyük A, Peker Y, Genc O, Oner K, et al. Diaphragmatic injuries: an analysis of 36 cases. Turkish Journal of Thoracic and Cardiovaskular surgery 2007; 15: 221-5.
  • Mihos P, Potaris K, Gakidis J, Paraskevopoulos J, Varvatsoulis P, Gougoutas B, Papadakis G, Lapidakis E. Traumatic rupture of the diaphragm: experience with 65 patients. Injury 2003; 34: 169-72.
  • Haciibrahimoglu G, Solak O, Olcmen A, Bedirhan MA, Solmazer N, Gurses A. Management of traumatic diaphragmatic rupture. Surg Today 2004; 34: 111-4.
  • Düzgün AP, Ozmen MM, Saylam B, Coşkun F. Factors influencing mortality in traumatic ruptures of diaphragm. Turk J Trauma Emerg Surg 2008; 14: 132-8.
  • Hanna WC, Ferri LE, Fata P, Razek T, Mulder DS. The current status of traumatic diaphragmatic injury: lessons learned from 105 patients over 13 years. Ann Thorac Surg, 2008; 85: 1044-8.
  • Bostancı H, Dikmen K, Sahin TT. Travmatik Diyafram Rüptürleri: Yirmi Hastanın Retrospektif Analizi. Gazi Medical Journal, 2012, 23.2.
  • Meyers BF, McCabe CJ. Traumatic diaphragmatic hernia. Occult marker of serious injury. Ann Surg 1993; 218: 783- 90.
  • Vatansev C, Aksoy F, Tekin S, Tekin A, Belviranli M, Kaynak A. Karın travmasında diyafragma rüptürü. Ulus Travma Acil Cerrahi Derg 2003; 9: 285-90.
  • Rubikas R, Diaphragmatic injuries. Eur J Cardiothorac Surg 2001. 20: 53-7.
  • Turhan K, Makay O, Cakan A, Samancilar O, Firat O, Icoz G, Cagirici U. Traumatic diaphragmatic rupture: look to see. Eur J Cardiothorac Surg 2008; 33: 1082-5.
  • Symbas PN, Vlasis-Hale SE, Picone AL, Hatcher CR Jr. Missiles in the heart. Ann Thorac Surg 1989; 48: 192-4.
Toplam 17 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Bölüm Research Article
Yazarlar

Arif Aslaner Bu kişi benim

Tuğrul Çakır Bu kişi benim

Umut Rıza Gündüz Bu kişi benim

Uğur Doğan Bu kişi benim

Burhan Mayir Bu kişi benim

Nurullah Bülbüller Bu kişi benim

Yayımlanma Tarihi 1 Ocak 2016
Yayımlandığı Sayı Yıl 2016 Cilt: 5 Sayı: 1

Kaynak Göster

APA Aslaner, A., Çakır, T., Gündüz, U. R., Doğan, U., vd. (2016). Retrospective Analysis of Twenty-four Patients with Traumatic Penetrating Diaphragmatic Ruptures. Abant Medical Journal, 5(1), 52-56. https://doi.org/10.5505/abantmedj.2016.68916
AMA Aslaner A, Çakır T, Gündüz UR, Doğan U, Mayir B, Bülbüller N. Retrospective Analysis of Twenty-four Patients with Traumatic Penetrating Diaphragmatic Ruptures. Abant Med J. Ocak 2016;5(1):52-56. doi:10.5505/abantmedj.2016.68916
Chicago Aslaner, Arif, Tuğrul Çakır, Umut Rıza Gündüz, Uğur Doğan, Burhan Mayir, ve Nurullah Bülbüller. “Retrospective Analysis of Twenty-Four Patients With Traumatic Penetrating Diaphragmatic Ruptures”. Abant Medical Journal 5, sy. 1 (Ocak 2016): 52-56. https://doi.org/10.5505/abantmedj.2016.68916.
EndNote Aslaner A, Çakır T, Gündüz UR, Doğan U, Mayir B, Bülbüller N (01 Ocak 2016) Retrospective Analysis of Twenty-four Patients with Traumatic Penetrating Diaphragmatic Ruptures. Abant Medical Journal 5 1 52–56.
IEEE A. Aslaner, T. Çakır, U. R. Gündüz, U. Doğan, B. Mayir, ve N. Bülbüller, “Retrospective Analysis of Twenty-four Patients with Traumatic Penetrating Diaphragmatic Ruptures”, Abant Med J, c. 5, sy. 1, ss. 52–56, 2016, doi: 10.5505/abantmedj.2016.68916.
ISNAD Aslaner, Arif vd. “Retrospective Analysis of Twenty-Four Patients With Traumatic Penetrating Diaphragmatic Ruptures”. Abant Medical Journal 5/1 (Ocak 2016), 52-56. https://doi.org/10.5505/abantmedj.2016.68916.
JAMA Aslaner A, Çakır T, Gündüz UR, Doğan U, Mayir B, Bülbüller N. Retrospective Analysis of Twenty-four Patients with Traumatic Penetrating Diaphragmatic Ruptures. Abant Med J. 2016;5:52–56.
MLA Aslaner, Arif vd. “Retrospective Analysis of Twenty-Four Patients With Traumatic Penetrating Diaphragmatic Ruptures”. Abant Medical Journal, c. 5, sy. 1, 2016, ss. 52-56, doi:10.5505/abantmedj.2016.68916.
Vancouver Aslaner A, Çakır T, Gündüz UR, Doğan U, Mayir B, Bülbüller N. Retrospective Analysis of Twenty-four Patients with Traumatic Penetrating Diaphragmatic Ruptures. Abant Med J. 2016;5(1):52-6.