Atilla EL, Kadir Hakan KAYABAŞ, Necdet GÜLER, Özgür SAMANCILAR, Cemal KARA, Turgay ÖZER, Arif UĞUZ, Erdoğan SÜ

Penetran diyafram yaralanmaları: 15 yıllık deneyim

Amaç: Bu çalışmada, penetran diyafram yaralanmalarının tanısı hakkında 15 yıllık deneyimimiz gözden geçirildi.Çalışma planı: Ocak 1994 - Aralık 2008 tarihleri arasında kliniğimizde penetran diyafram yaralanması tanısı konulan ve ameliyat edilen 37 hastanın (36 erkek, 1 kadın; ort. yaş 29.2 yıl; dağılım 17-46 yıl) kayıtları geriye dönük olarak incelendi.Bulgular: Yaralanmaların 31'i kesici-delici alet ile diğerleri ise ateşli silah yaralanması sonucu oluşmuş idi. Hastaların çoğunluğuna (n=34) laparotomi sırasında tanı konulabildi. Yaralanma genellikle sol hemidiyaframda (n=24) idi. Yirmi sekiz hastada (%75) eşlik eden organ yaralanması vardı ve en sık eşlik eden (n=14) yaralanma karaciğer yaralanması idi. Hastaların 26�sına sadece laparatomi, yedisine torakotomi ile birlikte laparotomi, üçüne sadece torakotomi ve birine de sadece laparoskopi uygulandı. Diyafram defektleri tüm olgularda primer tamir edildi. Üç olguda morbidite, üç olguda da mortalite görüldü.Sonuç: Travmatik diyafram yaralanmasının tanımlanmasından günümüze kadar geçen sürede tanı yöntemlerinde önemli gelişmeler olsa da, diyafram yaralanmasından şüphelenmek halen tanıda en önemli araçtır. Hem toraks hem de batın içi patoloji saptanan tek girişli penetran yaralanmaları diyafram hasarını akla getirmelidir. Penetran travma nedeniyle yapılan torakoabdominal ameliyatlarda diyafram dikkatlice eksplore edilmelidir.

Penetrating diaphragmatic injuries: A 15-year-experience

Background: In this study, we reviewed our 15-year-experience in the diagnosis of penetrating diaphragmatic injuries.Methods: The clinical records of 37 patients (36 males, 1 female; mean age 29.2 years; range 17 to 46 years) who were diagnosed as having penetrating diaphragmatic injury and were operated on in our clinic between January 1994 - December 2008 were evaluated retrospectively.Results: The majority of the injuries were caused by stabbing (n=31) and the rest by gun-shots. The diagnosis was established in most patients (n=34) during laparotomy. The injury was usually in the left hemidiaphragm (n=24). Twenty-eight patients (75%) had associated injuries and the most common was liver injury (n=14). Only laparotomy was performed in 26 patients, seven of them had laparotomy together with thoracotomy, three had only thoracotomy and one had only laparoscopy. The diaphragmatic defect was repaired primarily in all patients. Morbidity occurred in three cases and mortality also occurred in three cases.Conclusion: Although there has been great improvement in the diagnostic methods of diaphragmatic injury since it was first defined, a high index of suspicion is still the most important entity that leads to diagnosis. Penetrating injury with a single entry accompanied by thoracoabdominal pathology must be alerting of a diaphragmatic defect. Diaphragm must be explored carefully during the operation for thoracoabdominal penetrating trauma.

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