ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Diaphragmatic injuries: an analysis of 36 cases
Nazif Zeybek 1, Mehmet Eryılmaz2, Alper Gözübüyük3, Yusuf Peker 1, Onur Genç3, Köksal Öner 1, Cemil Turgut Tufan 1, Sedat Gürkök3
1Gülhane Askeri Tıp Akademisi, Genel Cerrahi Anabilim Dalı, Ankara
2Gülhane Askeri Tıp Akademisi, Acil Tıp Anabilim Dalı, Ankara
3Gülhane Askeri Tıp Akademisi, Göğüs Cerrahisi Anabilim Dalı, Ankara
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.

Keywords : Diaphragm/injuries; rupture/surgery
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