Importance of diagnostic laparoscopy in the assessment of the diaphragm after left thoracoabdominal stab wound: A prospective cohort study

BACKGROUND: Stab wounds in the left thoracoabdominal region may cause diaphragmatic injury. The aim of the present study was to determine incidence of diaphragmatic injury and role of diagnostic laparoscopy in detection of injury in patients with left thoracoabdominal stab wound.
METHODS: Total of 81 patients (75 male, 6 female; mean age 27.5±9.8 years; range 14 to 60 years) who presented with left thoracoabdominal stab wound between April 2009 and September 2014 were evaluated. Laparotomy was performed on patients who had hemodynamic instability, signs of peritonitis, or organ evisceration. Remaining patients were followed conservatively. After 48 hours, diagnostic laparoscopy was performed on patients without laparotomy indication to examine the left diaphragm for injury. Follow-up and treatment findings were prospectively evaluated.
RESULTS: Thirteen patients underwent laparotomy while diagnostic laparoscopy was performed on remaining 68 patients. Left diaphragmatic injury was observed in 19 patients (23.5%) in the study group. Four injuries were diagnosed by laparotomy and 15 were diagnosed by laparoscopy. Presence of hemopneumothorax did not yield difference in incidence of diaphragmatic injury (p=0.131). No significant difference was detected in terms of diaphragmatic injury with respect to entry site of stab wound in the thoracoabdominal region (p=0.929).
CONCLUSION: It is important to evaluate the diaphragm in left thoracoabdominal stab injuries, and diagnostic laparoscopy is still the safest and most feasible method.

Sol torakoabdominal bölge delici kesici alet yaralanmasý olan hastalarda diafragmanýn deðerlendirilmesinde tanýsal laparoskopinin önemi: Ýleriye yönelik kohort çalýþmasý

AMAÇ: Sol torakoabdominal bölge delici kesici alet yaralanmalarý potansiyel olarak diafragma yaralanmasýna neden olabilir. Bu çalýþmanýn amacý, sol torakaoabdominal bölge delici kesici alet yaralanmasý olan hastalarda diafragma yaralanmasýnýn insidansýný belirlemek ve laparoskopinin diafragma yaralanmasýný tespit etmedeki rolünü deðerlendirmek idi.
GEREÇ VE YÖNTEM: Nisan 2009 ve Eylül 2014 tarihleri arasýnda sol torakoabdominal bölge delici kesici alet yaralanmasý nedeniyle kliniðimize baþvuran 81 hasta (75 erkek, 6 kadýn; yaþ ortalamasý 27.5±9.8 yýl; daðýlým 14–60) çalýþmaya dahil edildi. Hemodinamik instabil, peritonit bulgularý ve organ eviserasyonu olan hastalara laparotomi yapýlýrken, diðer hastalar selektif konservatif olarak takip edildi. Laparotomi endikasyonu olmayan ve semptomsuz seyreden hastalara 48 saatlik gözlem sonunda sol diafragmayý deðerlendirmek için tanýsal laparoskopi uygulandý. Takip ve tedavi sonuçlarý ileriye yönelik olarak deðerlendirildi.
BULGULAR: On üç hastaya laparotomi, kalan 68 hastaya tanýsal laparoskopi uygulandý. Laparotomi yapýlan hastalarýn dördünde, tanýsal laparoskopi yapýlan hastalarýn ise 15’inde olmak üzere toplam 19 hastada (%23.5) sol diafragmada yaralanma tespit edildi. Hemopnömotoraks olan ve olmayan hasta gruplarý arasýnda diafragma yaralanmasýnýn insidansýnda fark saptanmadý (p=0.131). Diafragmatik yaralanma açýsýndan sol torakoabdominal bölgede delici kesici aletin giriþ yerleri arasýnda istatistiksel fark saptanmadý (p=0.929).
TARTIÞMA: Sol torakoabdominal bölge delici kesici alet yaralanmalarýnda diafragma deðerlendirilmelidir. Tanýsal laparoskopi, günümüzde hala bu amaçla kullanýlan en güvenli yöntemdir.