TRAUMATIC DIAPHRAGMATIC RUPTURES

The reported incidence of acute traumatic diaphragmatic ruptures (TDR) varies between 4.5% and 5.8.% Inadequacy of diagnostic procedures along with the associated severe organ injuries are the main reasons of late diagnosis and increasing mortality rates in these patients. TDR was diagnosed during the period of June 1990-January 1994. The diagnosis of TDR was established in these patients within the first 6 hours of their admittance. The diagnostic value of physical examination and chest x-rays were found to be 5% while the incidence of pathologic findings' were evaluated to be 45-50%, Prompt laparatomy was found to have an early diagnostic value in 45% of the cases. Mortality was calculated to be 30% in our cases all of them resulting from the associated severe other organ injuries.

TRAVMATÝK DÝYAFRAGMA RÜPTÜRLERÝ

Genel vücut travmalarý içinde Travmatik Diafragma Rüpterleri'ne (TDR) %4.5-5.8 oranýnda rastlanýr. Taný yöntemlerindeki yetersizlik nedeniyle tanýnýn geç konmasý ve/veya olaya eþlik eden ciddi organ yaralanmalarýnýn varlýðý bu olgularda mortalitenin %2'den %66'lara kadar yükselmesine neden olmaktadýr. Haziran 1990-Ocak 1994 döneminde Þiþli Etfal Hastanesi 3.Genel Cerrahi Kliniðine travma nedeniyle baþvuran olgularýn 20'sinde TDR saptandý. %85'i erkek, %15'i kadýn olan bu olgularýn tümünde taný ilk 6 saat içinde konuldu. Olgularýn %70'inde delici-kesici alet yaralanmasý, %15'inde ateþli silah yaralanmasý, %70'inde künt genel vücut travmasý vardý. Serimizde fizik muayene bulgularý ve toraks grafileri %5 oranýnda diagnostik, %45-50 oranýnda ise patolojik özellikteydi. Erken eksploratris laparotominin %45 oranýnda erken tanýsal deðeri olduðu saptandý. Olgularýn hepsinde diafraðma primer olarak tamir edildi. Mortalite %30 olarak saptanmýþ olup, hepsinde TDR'ye ilaveten ciddi organ yaralanmalarý vardý.