Onur GENÇ, Nazif ZEYBEK, Cemil Turgut TUFAN, Köksal ÖNER, Yusuf PEKER, Mehmet ERYILMAZ, Sedat GÜRKÖK, Alper GÖZÜBÜYÜK

Diyafram yaralanmaları: 36 olgunun analizi

Amaç: Son yıllarda ülkemizde şiddet olayları ile trafik kazalarındaki artışa bağlı olarak torakoabdominal yaralanmalı olguların sayısında artış gözlenmektedir. Bu çalışmada, travma sonrasında diyafram yaralanması olan olguların geriye dönük analizinden elde ettiğimiz 12 yıllık deneyimin paylaşılması amaçlandı. Çalışma planı: Ağustos 1994-2006 tarihleri arasında torakoabdominal yaralanma nedeniyle oluşan travmatik diyafram yırtığı tanısıyla tedavi edilen 36 olgunun (7 kadın, 29 erkek; ort. yaş 32; dağılım 17-71) dosya kayıtları incelendi. Hastalar yaş, cinsiyet, tanıya kadar geçen süre, tanı yöntemleri, diyafram yırtığının büyüklüğü ve yeri, eşlik eden yaralanma, tedavi yöntemleri, morbidite, mortalite ve hastanede yatış süresi açısından incelendi.Bulgular: Yaralanmaların 22’si (%61.1) penetran, 14’ü (%38.9) künt travma nedeniyle meydana gelmişti. Travma sonrası başvuru beş olgu (%13.9) dışında erken dönemde yapılmıştı. En sık gözlenen diyafram yırtığı nedeni (n=13, %36.1) ateşli silah yaralanması idi. Lezyonların 13’ü sağ, 23’ü sol hemidiyaframdaydı. Diyafram defektinin büyüklüğü penetran yaralanmalarda ortalama 1.2x3.1 cm, künt travmalarda 3.0x9.7 cm bulundu. Üç olguda defekt Prolen mesh takviyesi ile kapatıldı, diğerlerine ise primer tamir uygulandı. Biri erken dönem koagülopati, diğeri geç dönem sepsise bağlı multiorgan yetmezliği nedeniyle olmak üzere iki olgu (%5.6) kaybedildi. Hastanede yatış süresi ortalama 11.6 gün (dağılım 5-34 gün) idi.Sonuç: Travma sonrası klinik tetkikleri normal bulunsa dahi, şüpheli hastalarda sık gözlem ve ısrarcı arayış erken tanıya yardımcı olarak mortalite ve morbiditeyi düşürebilir.

Diaphragmatic injuries: an analysis of 36 cases

Background: Thoracoabdominal injuries have increased over the last years in parallel to increases in traffic accidents and violence. The purpose of this retrospective analysis was to share our 12-year experience gained from treatment of diaphragmatic injuries secondary to trauma. Methods: The study included 36 patients (7 females, 29 males; mean age 32 years; range 17 to 71 years) who received treatment for traumatic diaphragmatic ruptures due to thoracoabdominal trauma between August 1994 and 2006. The patients were evaluated with respect to age, sex, time to diagnosis, diagnostic methods, size and localization of diaphragmatic rupture, accompanying injuries, treatment methods, morbidity, mortality, and hospital stay.Results: Twenty-two ruptures (61.1%) were due to penetrating, and 14 ruptures (38.9%) were due to blunt injuries. All the patients presented within the early period except for five patients (13.9%). The most common etiology of diaphragmatic ruptures was gunshot wounds (n=13, 36.1%). Thirteen injuries were on the right, and 23 injuries were on the left diaphragm. The mean size of diaphragmatic defects was 1.2x3.1 cm in penetrating traumas, and 3.0x9.7 cm in blunt traumas. The defects were closed with primary repair in all cases but three which required Prolene mesh to provide support. Two patients died (5.6%), one from early coagulopathy, and the other from late multiorgan failure due to sepsis. The mean hospital stay was 11.6 days (range 5 to 34 days).Conclusion: Insistent and frequent control of suspected patients even those presenting with normal clinical findings after trauma may help early diagnosis and decrease morbidity and mortality.

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