Early Diagnosis and Management of Diaphragmatic Injuries
Abstract
ABSTRACTBackground: Diaphragmatic injury due to trauma, blunt and penetrating, can be overlooked and its clinical picture is that of associated organs injuries, and the diagnosis is made commonly during laparatomy.
Objectives: To evaluate patients with diaphragmatic rupture regarding preoperative diagnosis, radiological assessment, surgical treatment, morbidity and mortality.
Methods: During the period from Dec 2003 to Dec 2006, 73 patients had sustained traumatic rupture of the diaphragm due to penetrating injuries (gun shots and shells) and blunt trauma. Chest tubes applied to patients with respiratory distress with clinical signs of pneumo- or haemothorax or both, before chest x-ray. Laparatomy was the most common surgical approach.
Result: The mean age of patients was 25 years old. Males were the predominant victims. The left hemi-diaphragm was the most commonly injured site. Sixty five patients (89%) had penetrating injuries due to gun shots and shells. Eight patients (11%) had blunt trauma. The spleen was the most commonly associated injured organs. Chest x-ray was diagnostic in 20% of patients. In most patients the diagnosis of rupture diaphragm was made during laparatomy. Thoracic empyema was the most common complication. Mortality rate was 8%.
Conclusion: The morbidity and mortality are directly proportional to severity and number of associated organs injury, and to lag interval between time of injury and operation.
Keywords: Diaphragmatic rupture, Early diagnosis, Management.
Copyright (c) 2009 Iraqi Medical Journal
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