Diyafragma rüptürü: Tek bir kurum deneyimi ve literatürün gözden geçirilmesi

AMAÇ: Diyafragma rüptürü (DR) seyrek görülen, travma sonucu veya kendiliðinden oluþan yaþamý tehdit edici potansiyeli olan bir olaydýr. Bazen DR yaralanmadan birkaç ay sonra oluþur. Göðüs filmi ve bilgisayarlý tomografi en etkili tanýsal yöntemlerdir. Sýklýkla DR tanýsý gecikir. Bu çalýþmanýn amacý DR etiyoloji, klinik tablosu ve tedavisini incelemek ve daha iyi anlamaktýr.
GEREÇ VE YÖNTEM: Bu çalýþma Ýtalya, Milano I.R.R.C.S. Vakfý Cà Granda Hastanesi Acil ve Genel Cerrahi Bölümü Polikliniði’nde [Emergency and General Surgery Department of Fondazione I.R.R.C.S. Cà Granda, Ospedale Policlinico in Milan (Italy)] gerçekleþtirildi. 2001 ila 2011 yýllarý arasýnda DR tanýsý konup ameliyat geçirmiþ hastalar çalýþmaya dahil edilip geriye dönük olarak hastalarýn verileri toplandý.
BULGULAR: Çoðu sað tarafta DR olan 14 hastaya taný konmuþtur. Baþlýca neden trafik kazalarýydý (%86). Sekiz hastada (%57) ameliyat öncesi DR tanýsý konmuþtu. Göðüs filmi hastalarýn %50’sine taný koydurmuþ, üç olguda (%60) bilgisayarlý tomografi yararlý olmuþtur. On iki hastada diyafragma hernisi mevcuttu. Ýki olguda DR meþ ile onarýlmýþtýr. Ortalama hastanede kalýþ süresi 16.6 gün idi.
TARTIÞMA: Nonspesifik kliniði nedeniyle erken taný koymada zorluk yaþanmaktadýr. Çok kuþkucu olmak gerekir, tedavisi cerrahidir. Ýç organlar içeri itilir ve diyafragma defekti onarýlýr.

Diaphragmatic rupture: A single-institution experience and literature review

BACKGROUND: Diaphragmatic rupture (DR) is a rare and potentially life-threatening event caused by trauma or spontaneously. DR occasionally occurs several months after the injury. Chest X-ray and computed tomography are the most effective diagnostic methods. Delay in DR diagnosis occurs frequently. This study aimed to examine and improve our understanding of the etiology, clinical presentation, and management of DR.
METHODS: This study was performed at the Emergency and General Surgery Department of Fondazione I.R.R.C.S. Cà Granda, Ospedale Policlinico in Milan (Italy). Patients diagnosed with DR between 2001 and 2011 who underwent surgery were included, and their data were retrospectively collected.
RESULTS: Fourteen patients were diagnosed with DR, mainly left-sided DR. Road traffic collisions were the main causes (86%). DR diagnosis was preoperatively established in eight patients (57%). Chest X-ray was diagnostic in 50% of the patients and computed tomography in three patients (60%). Twelve patients had a diaphragmatic hernia. DR was repaired with a mesh in two patients. Mean hospital stay was 16.6 days.
CONCLUSION: Difficulty in achieving early diagnosis of DR is due to its nonspecific presentation. High index of suspicion is needed. Its treatment is using surgery involving reduction of the viscera and repair of the diaphragm defect.