Ulus Travma Acil Cerrahi Derg. 2007; 13(1): 70-73

Late complication of diaphragmatic gunshot injury: appendix perforation due to colon incarceration

Bilgi Baca, Tayfun Karahasanoðlu, Kaya Sarýbeyoðlu, Pýnar Arýca, Ece Kol
Department Of Ýstanbul University Cerrahpaþa Medical School, Istanbul Turkey

Missing the diaphragmatic injury on first admission is often associated with late complications. A 38 year-old male patient is presented here as a case of missed diaphragmatic injury due to gunshot injury resulted with fecal peritonitis. Celiotomy revealed a distended appendix perforation due to herniated left colon obstruction through the left pleural cavity. Left colon and stomach were reduced to peritoneal cavity and diaphragm was repaired with interrupted polypropylene sutures. After being sure about the viability of the colon and stomach, appendectomy with cecal exteriorization was performed. Postoperative period was uneventful. The patient was discharged on the 10th postoperative day. A thorough inspection of the diaphragm is essential in thoraco-abdominal trauma. Repair of the diaphragmatic defects should invariably carried out to avoid life-threatening complications.

Keywords: Hernia, diaphragmatic, traumatic/complications/diagnosis/surgery, missed diaphragmatic injury; tomography, X-Ray computed.

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Diyafragmatik ateþli silah yaralanmasýnýn geç komplikasyonu: Kolon inkarserasyonuna baðlý apendiks perforasyonu

Bilgi Baca, Tayfun Karahasanoðlu, Kaya Sarýbeyoðlu, Pýnar Arýca, Ece Kol
Ýstanbul Üniversitesi Cerrahpaþa Týp Fakültesi, Genel Cerrahi Anabilim Dalý, Ýstanbul

Diyafragma yaralanmalarýna ilk baþvuruda taný konulamamasý sýklýkla geç komplikasyonlara neden olur. Burada ateþli silah yaralanmasýna baðlý atlanmýþ diyafragma yaralanmasýnýn neden olduðu fekal peritonitli 38 yaþýndaki erkek hasta sunulmaktadýr. Laparotomi sýrasýnda sol plöral boþluða fýtýklaþmýþ sol kolon obstrüksiyonuna ikincil diyastatik apendiks perforasyonu saptandý. Fýtýk defekti geniþletilerek, mide ve sol kolon karýna doðru redükte edildi ve diyafragmatik fýtýk polipropilen devamlý dikiþlerle tamir edildi. Mide ve kolonun canlýlýðýndan emin olduktan sonra, apandektomiyi takiben çekal eksteriorizasyon uygulandý. Ameliyat sonrasý dönemde herhangi bir komplikasyonla karþýlaþýlmadý ve hasta ameliyat sonrasý 10. günde taburcu edildi. Torako-abdominal travmalarda diyafragmanýn tümüyle gözden geçirilmesi gereklidir. Yaþamý tehdit edici komplikasyonlarý önlemek amacýyla tüm diyafragma yaralanmalarý onarýlmalýdýr.

Anahtar Kelimeler: Fýtýk, travmatik diyafragma/komplikasyonlar/ taný/cerrahi, fark edilmemiþ diyafragma yaralanmasý; tomografi, X-ýþýný kompütörize

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