sdü tıp fak derg

Medical Journal of Süleyman Demirel University

2602-2109

Süleyman Demirel Üniversitesi

10.17343/sdutfd.295606

Clinical Sciences

Klinik Tıp Bilimleri

KOLON PERFORASYONU İLE SONUÇLANAN GEÇ TANI KONMUŞ TRAVMATİK DİYAFRAGMA YARALANMASI: BİR VAKA TAKDİMİ

Özcan

Mustafa Soner

Servergazi Devlet Hastanesi Peker

Gökhan

Servergazi Devlet Hastanesi Türk

Tarık

Servergazi Devlet Hastanesi Öztekin

Mehmet Gürdal

Servergazi Devlet Hastanesi

12 01 2017

24 4 173 177 03 01 2017

1994

Süleyman Demirel Üniversitesi Tıp Fakültesi Dergisi

ÖZETGiriş:Travmatik diafragma yaralanmaları sık görülmeyen ancak yüksek morbidite vemortaliteye neden olabilen bir durumdur. Künt travmatik diyafragma rüptürü ensık motorlu taşıt kazaları sonucu olmaktadır. Asemptomatik seyreden Travmatikdiyafragma yaralanmaları yıllar sonra diafragma hernisine bağlıgastrointestinal yada pulmoner sistem semptomları ile karşımızaçıkabilmektedir.Vaka:65 yaşında, geçirilmiş trafik kazası hikayesi olan kadın hasta, ciddi nefesdarlığı ve karın ağrısı şikayeti ile hastanemize başvurdu. Sol hidropnömotorakssaptandı ve tüp torakostomi uygulandıktan sonra, kapalı sualtı drenaj sisteminebir hafta sonunda bağırsak içeriğinin gelmesi üzerine, acil sol torakotomi velaparotomi yapıldı. Transvers kolon batın içine alınıp nekroze olan kısım rezekeedildi ve kolostomi açıldı. Hastaya postoperatif dönemde yoğun bakım ünitesinde9 gün sepsis durumu ile takip ve tedaviedildi. Ardından servisteki 20 günlük izlemin ardından sorunsuz taburcu edildi.Sonuç:Torakoabdominal yaralanma geçiren hastalarda yapılan tüm radyolojikincelemelerde bulgu saptanmasa bile, hastalar diafragma yaralanması konusundadikkatlice incelenmelidir. Geçikmiş tanı hayatı tehdit eden durumlara yolaçabilir. Dikkatli ve uygun yaklaşımla yüksek morbidite ve mortalite ile seyredenkomplikasyonlar açısından erken tanı konabilir.ABSTRACTIntroduction:Traumatic diaphragmatic injuries are uncommon injuries but cause high mortalityand morbidity. Motor vehicle accidents are the most common cause of blunt traumaticdiaphragmatic rupture. After years, asymptomatic patients with Traumaticdiaphragmatic injuries may be presented with gastrointestinal and pulmonarysymptoms due to diaphragmatic hernia. Case: 65 year-old female patient with a history oftraffic accident was admitted to our hospital with severe dyspnea and abdominalpain. Left hydropneumothorax was detected. 7 days after the tube thoracostomyprocedure, emergency thoracotomy and laparotomy was performed because ofintestinal contents coming from closed underwater drainage system. Thetransverse colon was taken back to abdomen, necrosis area was resected, andcolostomy was opened. The patient with sepsis status was treated and followed 9days in Intensive Care Unit. Then, 20 days after the follow up in the clinic,she was discharged without any problems.Result:Although there are no findings detected on all radiological examinations inpatients with thoracoabdominal injuries, the patients should be carefullyexamined for diaphragmatic injuries. Delayed diagnosis may lead to lifethreatening conditions. With careful and appropriate approaches, earlydiagnosis may be made for complications with high mortality and morbidity

Travmatik Diyafragmatik Yaralanma Travmatik Diyaframa Hernisi İntestinal perforasyon Gecikmiş Tanı

1. Meyers BF, McCabe CJ. Traumatic diaphragmatic hernia. Occult marker of serious injury. Annals of surgery. 1993;218(6):783.

2. Lopez PP, Arango J, Gallup TM, Cohn SM, Myers J, Corneille M, et al. Diaphragmatic injuries: what has changed over a 20-year period? The American Surgeon. 2010;76(5):512-6.

3. Goh BK, Wong AS, Tay K-H, Hoe MN. Delayed presentation of a patient with a ruptured diaphragm complicated by gastric incarceration and perforation after apparently minor blunt trauma. CJEM. 2004;6(04):277-80.

4. Toh C, Yeo T, Chua C, Low C. Diaphragmatic injuries: why are they overlooked? Journal of the Royal College of Surgeons of Edinburgh. 1991;36(1):25-8.

5. Zarour AM, El-Menyar A, Al-Thani H, Scalea TM, Chiu WC. Presentations and outcomes in patients with traumatic diaphragmatic injury: a 15-year experience. Journal of Trauma and Acute Care Surgery. 2013;74(6):1392-8.

6. Chatzoulis G, Papachristos IC, Daliakopoulos SI, Chatzoulis K, Lampridis S, Svarnas G, et al. Septic shock with tension fecothorax as a delayed presentation of a gunshot diaphragmatic rupture. Journal of thoracic disease. 2013;5(5):E195.

7. Özgüç H, Akköse Ş, Şen G, Bulut M, Kaya E. Factors affecting mortality and morbidity after traumatic diaphragmatic injury. Surgery today. 2007;37(12):1042-6.

8. Morgan B, Watcyn-Jones T, Garner J. Traumatic diaphragmatic injury. Journal of the Royal Army Medical Corps. 2010;156(3):139-44.

9. Childress M, Grimes O. Immediate and remote sequelae in traumatic diaphargmatic hernia. Surgery, gynecology & obstetrics. 1961;113:573.

10. Pappas-Gogos G, Karfis E, Kakadellis J, Tsimoyiannis E. Intrathoracic cancer of the splenic flexure. Hernia. 2007;11(3):257-9.

11. Lu J, Wang B, Che X, Li X, Qiu G, He S, et al. Delayed traumatic diaphragmatic hernia: A case-series report and literature review. Medicine. 2016;95(32).

12. Vermillion J, Wilson E, Smith R. Traumatic diaphragmatic hernia presenting as a tension fecopneumothorax. Hernia. 2001;5(3):158-60.

13. Chen J, Wilson S. Diaphragmatic injuries: recognition and management in sixty-two patients. The American surgeon. 1991;57(12):810-5.

14. Voeller G, Reisser J, Fabian T, Kudsk K, Mangiante E. Blunt diaphragm injuries. A five-year experience. The American surgeon. 1990;56(1):28-31.

15. Grimes OF. Traumatic injuries of the diaphragm: Diaphragmatic hernia. The American Journal of Surgery. 1974;128(2):175-81.

16. Ozkan OV, Semerci E, Yetim I, Davran R, Diner G, Paltaci I. Delayed diagnosis of traumatic diaphragmatic hernia may cause colonic perforation: a case report. Cases journal. 2009;2(1):6863.

17. Magu S, Agarwal S, Singla S. Computed tomography in the evaluation of diaphragmatic hernia following blunt trauma. Indian Journal of Surgery. 2012;74(4):288-93.