Ufuk ÇOBANOĞLU, Duygu MERGAN, İrfan YALÇINKAYA, Fuat SAYIR, Metin ER, Ahmet Feridun IŞIK, Volkan KARA

Traumatic diaphragmatic ruptures: diagnostic and therapeutic approaches

Amaç: Bu çalışmada travmatik diyafram rüptürü (TDR) olan hastaların özellikleri ve bu hastalarda uygulanan tanı ve tedavi yaklaşımları ve elde edilen sonuçlar değerlendirildi. Çalışma planı: Ocak 2000 - Ocak 2010 tarihleri arasında kliniğimizde tedavi edilen TDR tanılı ve torakoabdominal travmalı 41 hasta (31 erkek, 10 kadın; ort. yaş 41.9 yıl; dağılım 7-71 yıl) retrospektif olarak analiz edildi. Hastalar yaş, cinsiyet, tanının erken veya geç konulmuş olması, tanı- amaçlı yapılmış olan incelemeler, rüptür tanısının ameliyat sırasında veya sonrasında konulması, rüptürün yerleşimi, rüptürün çapı, eşlik eden yaralanmalar, uygulanan ameliyat, morbidite ve mortalite ile travma yaralanma ciddiyet skoru yönünden istatistiksel olarak karşılaştırıldı. Bulgular: Diyafram rüptürü, hastaların %43.9’unda künt travmaya, %56.10’unda penetre travmaya bağlı olarak meydana gelmiş idi. Hastaların %85.36’sında tanı erken dönemde, %14.64’ünde geç dönemde konuldu. Herniasyon tanısı 18 hastada (%43.9) radyolojik olarak konuldu, 23 hastada (%56.10) ise ameliyat sırasında diafram rüptürü tespit edildi. Hastaların 29’una (%70.73) torakotomi, yedisine (%17.02) laparotomi, beşine (%12.19) torakotomi+ laparotomi yapıldı. Genel mortalite oranı %14.63 (n=6) idi. Sonuç: Travmatik diyafram rüptürleri herniye olan intraabdominal organ strangülasyonlarına bağlı olarak ölümcül seyredebilen yaralanmalardır. Tüm multitravmalı hastalarda TDR’den şüphelenilmeli ve bu olgular kesin tanı ve tedavi planı için ciddi bir şekilde değerlendirilmelidir.

Travmatik diyafram rüptürleri: Tanı ve tedavi yaklaşımları

Background: This study aims to evaluate the characteristics of patients with traumatic rupture of diaphragm (TDR), the diagnostic and therapeutic approaches used in these cases and and the outcomes of the patients. Methods: F orty-one p atients (31 m ales, 10 f emales; m ean age 41.9 years; range 7 to 71 years) with thoracoabdominal trauma and diagnosis of TDR who were treated in our clinic between January 2000 and January 2010 were analyzed retrospectively. The patients were statistically compared in terms of age, gender, the time of diagnosis (early or late), the diagnostic procedures that were performed, whether the diagnosis of rupture was made during or after the operation, the localization of the rupture, the diameter of the rupture, accompanying injuries, the surgery performed, mortality and morbidity and the trauma injury severity score. Results: The etiology for the diaphragmatic rupture was blunt trauma in 43.9% and penetrating trauma in 56.10% of the patients. 85.36% of the patients were diagnosed in early stage and 14.64% in late stage. Herniation dignosis was made radiologically in 18 (43.9%) patients and diaphragmatic rupture was detected during the operation in 23 patients (56.1%). Twenty-nine (70.73%) patients had thoracotomy, seven (17.02%) patients had laparatomy and five (12.19%) patients had thoracotomy plus laparatomy. The overall mortality rate was 14.63% (n=6). Conclusion: Traumatic diaphragmatic ruptures may have a fatal course depending on the strangulation of the herniating abdominal viscera. Traumatic diaphgram rupture should be suspected in all multitraumatic patients and these cases shuld be seriously evaluated for the definitive diagnosis and treatment plan.

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