Traumatic diaphragmatic rupture: results of the chest surgery clinic

BACKGROUND: Traumatic diaphragmatic rupture is an urgent and life-threatening condition concerning the branches of chest surgery and general surgery because of the accompanying injuries. We reviewed the results of our cases with traumatic diaphragmatic rupture who were operated over a period of 9 years. METHODS: The patients who underwent surgery for traumatic diaphragmatic rupture in Department of Chest Surgery Medicine Faculty of Yuzuncu Yýl University were included into the study. The diagnosis was established by chest X-ray, computerized thoracic tomography, abdominal ultrasonography, and contrast upper gastrointestinal imaging modalities when needed. RESULTS: Twenty-six cases (21 males, 5 females; mean age 33; range 13 to 67 years) with traumatic diaphragmatic rupture were operated in Department of Chest Surgery Medicine Faculty of Yuzuncu Yýl University between August 1996 and October 2005. Treatment approach in 15 cases was thoracotomy, in 7 cases laparotomy and in 4 cases thoracotomy + laparotomy, and in all cases, diaphragma was primarily sutured. Left diaphragmatic rupture was detected in 18 cases and right diaphragmatic rupture in 8 cases. Laceration in the diaphragma ranged between 0.5 and 15 cm. Various accompanying injuries were present in all cases except one. Abdominal organs were herniated to the thorax in 12 cases. Three cases who were operated on urgently with severe accompanying injuries died. There was no mortality in the postoperative period and morbidity occurred in 5 cases. CONCLUSION: Traumatic diaphragmatic rupture, when overlooked and accompanied with severe injuries, can cause complications and even death. Its diagnosis and treatment must be dealt with rapidly and cautiously.

Travmatik diyafram yýrtýðý: Bir göðüs cerrahisi kliniðindeki sonuçlar

AMAÇ: Travmatik diyafram yýrtýðý, göðüs cerrahisi ve genel cerrahi branþlarýný ilgilendiren, eþlik eden yaralanmalar nedeniyle acil ve hayati tehdit oluþturabilen bir durumdur. Bu çalýþmada, dokuz yýl içinde ameliyat edilen travmatik diyafram yaralanmalý olgulardaki sonuçlar deðerlendirildi. GEREÇ-YÖNTEM: Yüzüncü Yýl Üniversitesi Göðüs Cerrrahisi Anabililim Dalý’nda ameliyat edilen travmatik diyafram yýrtýklarý çalýþmaya alýndý. Taný direkt akciðer grafisi, bilgisayarlý toraks tomografisi, karýn ultrasonografisi ve gerektiðinde kontrastlý üst gastrointestinal inceleme ile konuldu. BULGULAR: Aðustos 1996-Ekim 2005 tarihleri arasýnda Yüzüncü Yýl Üniversitesi Týp Fakültesi Göðüs Cerrahisi Anabilim Dalý’nda 26 travmatik diyafram yaralanmalý olgu (21 erkek, 5 kadýn; ort. yaþ 33; daðýlým 13-67) ameliyat edildi. On beþ olguda torakotomi, yedi olguda laparotomi, dört olguda ise torakotomi + laparotomi yapýldý ve hepsinde diyaframa primer tamir uygulandý. On sekiz olguda sol, sekiz olguda sað diyaframda yýrtýk saptandý. Diyaframdaki laserasyon 0,5-15 cm arasýnda deðiþiyordu. Biri dýþýnda diðer olgularda, çeþitli eþlik eden yaralanmalar da vardý; 12 olguda karýn organlarý toraksa herniye idi. Acil olarak ameliyata alýnan ve ciddi yaralanmalarýn eþlik ettiði üç olgu ameliyat sýrasýnda hayatýný kaybetti. Ameliyat sonrasý dönemde mortalite olmadý, morbidite beþ olguda meydana geldi. SONUÇ: Travmatik diyafram yýrtýðý gözden kaçýrýldýðýnda ve eþlik eden ciddi yaralanmalar olduðunda komplikasyonlara ve hatta ölüme bile neden olabilir. Taný ve tedavisi hýzlý ve dikkatli bir þekilde ele alýnmalýdýr.