Diaphraghmatic injuries are rare (5-7%), usually secondary to blunt, or more rarely penetrating, thoracic or abdominal trauma. The most frequent site of trauma is the left postero-lateral region. We’ll try to review this pathology in all its aspects. MATERIALS AND METHOD: We report our personal experience from January 2002 to December 2004 on 280 thoracoabdominal trauma, 262 (93.5%) blunt and 18 (6.5%) penetrating, of which 5 (3.7%) interested the diaphragm. 4 following a blunt trauma and 1 an open trauma (gunshot) Each trauma was evaluated for possible associated injuries and for the type of symptoms at the admission and during the hospitalization. Preoperative diagnosis has been obtained only in 3 patients, haemodynamically stable. In the other 2 cases an emergency laparotomy was carried out because of their critic conditions and the diaphragmatic injuries were recognized during the procedure. Two patients died. CONCLUSIONS: We remark as during the acute phase the diaphragmatic rupture may be missed because of shock, respiratory insufficiency or coma of the patient; however, it’s mandatory that the right diagnosis is reached as soon as possible in order that mortality is mostly influenced by the time elapsing between trauma and diagnosis.
Le lesioni del diaframma rappresentano un’evenienza rara (5-7%), causate principalmente da traumi chiusi toracici o addominali e, più raramente, da quelli penetranti. La sede più interessata è la pozione postero-laterale sinistra. Gli AA. riportano la loro esperienza dal Gennaio 2002 al Dicembre 2004 su 280 traumi toracici ed addominali, 262 (93,5%) chiusi e 18 (6.5%) aperti: le lesioni diaframmatiche furono 5 (3,7%) di cui 4 fra trauma chiuso ed 1 penetrante (da arma da fuoco). Di ognuno è stata valutata la presenza di eventuali lesioni e la sintomatologia all’arrivo al pronto soccorso e durante il ricovero. La diagnosi pre-operatoria è stata effettuata solo in 3 pazienti emodinamicamente stabili. Negli altri 2 casi si è intervenuto in emergenza a causa delle loro gravi condizioni e la lesione diaframmatica è stata riscontrata in corso di intervento operatorio. Due pazienti (40%) sono deceduti. Gli AA. sottolineano come, in fase acuta, la rottura diaframmatica, può non essere riconosciuta per lo stato di shock, insufficienza respiratoria o coma in cui si trova il paziente, ma la diagnosi deve essere posta quanto più precocemente possibile in quanto la mortalità dipende da diversi fattori tra cui il tempo intercorso dal trauma alla diagnosi.
Traumi del diaframma. Esperienza personale [Diaphragmatic traumas. Personal experience]
BUFFONE, Antonino;BASILE, Guido;
2006-01-01
Abstract
Diaphraghmatic injuries are rare (5-7%), usually secondary to blunt, or more rarely penetrating, thoracic or abdominal trauma. The most frequent site of trauma is the left postero-lateral region. We’ll try to review this pathology in all its aspects. MATERIALS AND METHOD: We report our personal experience from January 2002 to December 2004 on 280 thoracoabdominal trauma, 262 (93.5%) blunt and 18 (6.5%) penetrating, of which 5 (3.7%) interested the diaphragm. 4 following a blunt trauma and 1 an open trauma (gunshot) Each trauma was evaluated for possible associated injuries and for the type of symptoms at the admission and during the hospitalization. Preoperative diagnosis has been obtained only in 3 patients, haemodynamically stable. In the other 2 cases an emergency laparotomy was carried out because of their critic conditions and the diaphragmatic injuries were recognized during the procedure. Two patients died. CONCLUSIONS: We remark as during the acute phase the diaphragmatic rupture may be missed because of shock, respiratory insufficiency or coma of the patient; however, it’s mandatory that the right diagnosis is reached as soon as possible in order that mortality is mostly influenced by the time elapsing between trauma and diagnosis.File | Dimensione | Formato | |
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