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Traumatic rupture of the diaphragm
A Cubukçu1, M Paksoy, N N Gönüllü
1Kocaeli University, Medical Faculty, Turkey.
International Journal of Clinical Practice
|April 6, 2000
Summary
Traumatic rupture of the diaphragm (TRD) is often missed, with diagnosis typically occurring during surgery. A high suspicion is crucial for preoperative diagnosis, and most TRD cases can be repaired via abdominal surgery.
Area of Science:
- Trauma Surgery
- Thoracic Surgery
- Surgical Diagnosis
Background:
- Traumatic rupture of the diaphragm (TRD) is a frequently associated and overlooked injury following trauma.
- Diagnosis of TRD is challenging and often delayed until intraoperative findings.
Purpose of the Study:
- To report institutional experiences with traumatic rupture of the diaphragm (TRD).
- To review the existing literature on TRD diagnosis and management.
Main Methods:
- Retrospective analysis of 21 patients with TRD between 1995 and 1998.
- Review of patient records, focusing on injury mechanisms, clinical presentation, and surgical outcomes.
- All patients underwent midline laparotomy for surgical repair.
Main Results:
- 12 penetrating and 9 blunt injuries were identified.
- Right-sided diaphragmatic defects were more common (12 vs 9).
- Only 7 patients (33%) had symptoms directly related to TRD.
- 20 patients (95%) had associated injuries, most commonly liver (10 patients).
- Diaphragmatic hernia was observed in 6 patients (28.5%).
Conclusions:
- A high index of suspicion is essential for the preoperative diagnosis of TRD.
- Intraoperative diagnosis is frequently achieved through explorative laparotomy.
- The abdominal approach is effective for repairing most diaphragmatic ruptures.