Traumatic diaphragm ruptures

Objective: Traumatic diaphragm rupture is an easily missed complication following blunt or penetrating thoracoabdominal injury. Missing of diaphragm ruptures, increases the related complications, morbidity and mortality.
Study Design: Between January 1998 - January 2003, 10 patients whom were operated due to traumatic diaphragm rupture were evaluated according to age, gender, occurrence of trauma, clinical symptoms, diagnostic assays, accompanying pathologies, operative findings, repair technique, morbidity and mortality.
Results: Nine cases were male and one was female, with a median age of32 (25-44) years. Occurence of the trauma and accompanying organ injuries are; 6 cases were penetrating injury (3 cases of gunshot wounds with liver and spleen injury, 2 cases of stab wounds with liver and 1 case of stab wound with spleen, small bowel injury), 4 cases were blunt trauma due to traffic accident (2 cases with spleen injury and 2 cases with spleen, small bowel injury). The accurate diagnosis was made in the first attendance in 9 cases and 48 hours after in one case. Laparotomy was performed in all cases without necessity for thoracotomy and diaphragm was primarily repaired in all cases. Two cases had pleural effusion after the operation. All patients have discharged from hospital without complication. Median hospital stay is 9.2 days, mean follow- up period is 10 months.
Conclusions: The traumatic rupture of the diaphragm, can easily be missed during the acute period of the trauma. The main and valuable diagnostic tool is PA chest X-ray.Diagnostic laparoscopy could be performed for evaluation and treatment. The main point for its diagnosis is the consideration of its existence.

Diafragmanm travmatik rüptürleri

Amaç: Travmatik diafragma rüptürii, kiint ve penetran tora- koahdominal yaralanmalarý takiben görülen ve kolaylýkla gözden kaçabilen bir komplikasyondur. Diafragma rüptürünün atlanmasý, buna baðlý komplikasyonlarý, morbidité ve mortaliteyi artýrýr.
Gereç ve Yöntem: Travmatik diafragma riiptiirii tanýsýyla Ocak 1998-Ocak 2003 tarihleri arasýnda ameliyat edilen 10 hasta: yaþ, cinsiyet, travmanýn oluþma þekli, hastanýn þikayet¬leri. taný yöntemleri, eþlik eden patolojiler, ameliyat bulgula¬rý, kullanýlan onarým tekniði, morbidité ve mortalité açýsýn¬dan deðerlendirildi.
Bulgular: Hastalarýn 9’u erkek, J’i kadýndý, ortalama yaþ 32 yýl (25-44) idi. Altý hasta penetran, 4 hastada kiiýýt travma sonrasý hastaneye baþvurmuþtu. Travmanýn oluþma þekli ve ek organ yaralanmalarý; 6 olguda penetran yaralanma (3 hastada ateþli silah yaralanmasýna baðlý karaciðer ve dalak yaralanmasý, 2 hastada delici-kesici alet yaralanmasýna baðlý karaciðer yaralanmasý ve I hastada delici-kesici alet yara¬lanmasýna baðlý dalak ve ince barsak yaralanmasý), 4 olguda trafik kazasýna baðlý kiiýýt travma (2 olguda dalak yaralanma¬sý, 2 olguda ise dalak ve irice barsak yaralanmasý) þeklindey¬di. Kesin taný 9 hastada hastaneye ilk baþvuru sýrasýnda, I hastada ise 48 saat sonra koyuldu. Tüm olgulara torakotomi ihtiyacý olmaksýzýn, laparotomi uygulandý ve tüm olgularda diafragma primer olarak onarýldý. Ameliyatý takiben 2 hasta¬da plevral ejfiizyon geliþti. Tüm hastalar þifa ile taburcu edil¬di. Ortalama hastanede yatýþ süresi 9.2 gün, hastalarýn ortalama takip süresi 10 aydýr.
Sonuçlar: Diafragnýanýn travmatik rüptürii, travmanýn akut döneminde kolaylýkla gözden kaçabilir. PA akciðer grafisi, travmatik diafragma rüptürii tanýsýnda deðerli bir araçtýr. Ta¬ný ve tedavi için diagnostik laparoskopi yapýlabilir. Diafrag¬ma rüptürürün tanýsýnda en önemli kriter, riiptiir olabileceðinden þüphelenilmesidir