Management of Traumatic Diaphragmatic Injury: Retrospective study of 19 cases

Öz

Traumatic diaphragmatic injury (TDI) is a relatively rare condition. It has a high tendency to be missed without comprehensive clinical evaluation and imaging examination. The aim of this study is to review our diagnostic and therapeutic outcomes in patients who underwent thoracic surgery for TDI. This study is a retrospective case series of all consecutive patients who presented to our emergency de-partment and surgical clinic during the last 4 years and developed TIA after chest trauma. Demographic data, type of chest injury (blunt and penetrating), cause of diaphragmatic injury, clinical and radiologic examinations, intraoperative findings and complications were reviewed. A total of 926 patients with chest trauma were obtained from the records between August 2020 and December 2024. Of these 926 patients, 19 (2.05%) had TDI. Indications for surgery were massive hemothorax requiring thoracoscopy in 8 patients (42.1%), hearing bowel sounds on thorax auscultation during clinical evalu-ation in 7 patients (36.8%), and findings of diaphragmatic injury on chest radiography and contrast-enhanced computed tomography. In two patients (10.5%), the defect in the diaphragm was detected in the coronal section of computed tomography taken as a result of severe flank and shoulder pain, in 1 patient (5.2%), intestinal contents came from the chest tube inserted to drain hemopneumothorax, and in 1 patient (5.2%), although the amount of drainage from the chest tube decreased, its color did not lighten. TDI is an injury that can be missed by emergency, thoracic and general surgery specialists. Interruption of diaphragmatic continuity in the coronal section of thoracic computed tomography is an important sign. Thoracoscopy or laparoscopy should be considered in suspected diaphragmatic injury.

Anahtar Kelimeler

• Diaphragmatic injury
• Diagnosis
• Treatment

Travmatik Diyafragma Yaralanmasının Yönetimi: Retrospektif 19 olgu çalışması

Öz

Travmatik diyafragma yaralanması (TDY) nispeten nadir bir durumdur. Kapsamlı klinik değerlendirme ve görüntüleme incelemesi yapılmazsa yüksek oranda gözden kaçma eğilimi vardır. Bu çalışmanın amacı TDY nedeniyle torasik yolla cerrahi uyguladığımız hastalarda tanı ve tedavi sonuçlarımızı gözden geçirmektedir. Bu çalışma, son 4 yıl boyunca acil servis ve cerrahi kliniğimize başvuran ve göğüs travması sonrası TDY gelişen ardışık tüm hastaların retrospektif bir vaka serisidir. Hastaların demografik verileri, göğüs yara-lanmasının tipi (künt ve penetran), diyafragma yaralanmasının nedeni, klinik ve radyolojik incelemeleri, intra-operatif bulgular ve komplikasyonları derlenmiştir. Ağustos 2020 ile Aralık 2024 tarihleri arasındaki kayıtlardan toplam 926 göğüs travmalı hasta elde edilmiştir. Bu 926 hastanın 19'unde (%2,05) TDY vardı. Cerrahi endikasyonları; 8 hastada (%42,1) torakoskopi gerektiren masif hemotoraks, 7 hastada (%36,8) klinik değerlendirme sırasında toraks oskültasyonunda bağır-sak sesinin duyulması ve akciğer grafisi ve kontrastlı bilgisayarlı tomografi incelemelerinde diyafragma yara-lanması bulguları idi. İki hastada (%10,5) şiddetli yan ve omuz ağrısı sonucu çekilen bilgisayarlı tomografinin koronal kesitte diyafragmadaki defektin saptanması, 1 hastada (%5,2) hemopnömotoraksı drene etmek için takılan göğüs tüpünden bağırsak içeriğinin gelmesi, 1 hastada (%5,2) ise göğüs tüpünden gelen drenajın mikta-rının azalmasına rağmen renginin açılmaması idi. TDY acil, göğüs ve genel cerrahi uzmanları için atlanabilen bir yaralanmadır. Toraks bilgisayarlı to-mografinin koronal kesitinde dayafragmanın devamlılığının kesintiye uğraması önemli bir işarettir. Diyafragma yaralanması şüphesinde torakoskopi veya laparaskopi mutlaka düşünülmelidir.

Anahtar Kelimeler

• Diyafragma yaralanması
• Tanı
• Tedavi

Kaynakça

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