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Fiber-endoscopic thoracoscopy for diaphragmatic injury in children
1Division of Paediatric Surgery, University of the Witwatersrand, Johannesburg Hospital, Johannesburg, South Africa.
Insights
Diagnosing diaphragmatic injuries early prevents complications. A novel endoscopic technique using a standard gastroscope as a thoracoscope offers a safe, reliable, and cost-effective method for emergency department assessment.
Area of Science:
- Thoracic surgery
- Gastroenterology
- Emergency medicine
Background:
- Diaphragmatic injuries require prompt diagnosis to avoid serious complications like herniation and gangrene.
- Current diagnostic methods may have limitations in emergency settings.
- A need exists for a safe, reliable, and inexpensive assessment tool.
Observation:
- A novel technique utilizes a standard fiberoptic upper gastrointestinal endoscope as a thoracoscope.
- The endoscope is inserted through a thoracostomy tube incision for diaphragmatic visualization.
- This approach was evaluated in two patient cases within the emergency department.
Findings:
- The endoscopic technique provided an adequate view of the diaphragm.
- The procedure was well-tolerated by patients.
- It facilitated prompt decision-making in the management of suspected diaphragmatic injuries.
Implications:
- This method offers a potentially valuable tool for emergency physicians diagnosing diaphragmatic injuries.
- It may reduce the need for more invasive diagnostic procedures.
- Widespread adoption could improve patient outcomes by enabling earlier intervention.
Abstract:
Diagnosis of a diaphragmatic injury is important to prevent late sequelae of herniation of abdominal viscera and intestinal gangrene. A safe, simple, reliable and inexpensive method of assessing the diaphragm was devised for use in the emergency department. A standard fiberoptic upper gastrointestinal endoscope was used as a thoracoscope to visualize the diaphragm, using the thoracostomy tube incision as the portal of entry to the thoracic cavity. Two cases in which this technique was used are presented. The procedure was well tolerated and allowed for an adequate view of the diaphragm and prompt decision making.