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Journal of The Korean Society of Emergency Medicine 1995;6(1): 48-57. |
| TRAUMATIC INJURIES OF THE DIAPHRAGM |
| Yong Ho Kim1, Sang Mok Lee1, Young Gwan Ko1, Ho Chul Park1, Kee Hyung Lee1, Suck Hwan Koh1, Sung Kook Ahn2, Kyu Seok Cho2 |
1Department of General Surgery, College of Medicine, Kyung Hee University
2Department of Thoracic Cardiovascular Surgery, College of Medicine, Kyung Hee University |
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Published online: June 30, 1995. |
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| ABSTRACT |
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Fifty two cases of traumatic diaphragmatic injuries that we have experienced from Jan. 1973 to Oct. 1994 were evaluated.
The following results were obtained.
The age of the patient was ranged from 1 to 74 years. Male was 38 and female was 14 in number with a ratio of 2.7 : 1.
The traumatic diaphragmatic injuries were due to blunt trauma in 35 cases(motor vehicle accident 25, fall down 8, press 1, kick by fight 1 ) and penetrating trauma in 17 cases(stab wound 15, shot wound 1, explosion 1 ).
In the blunt trauma, the preoperative diagnosis of the diaphragmatic injury was possible in 25 out of 35 cases(71 %) and in the penetrating trauma, 15 out of 17 cases(88%).
In the blunt trauma, the rupture site was located in the left in 22 cases(63%) and in the right in 13 cases(31%). In the penetrating trauma, the rupture site was located in the left in 9 cases(53%) and in the right in 8 cases(47%).
In the blunt trauma, 20 cases(63%) were treated within 24 hours and in the penetrating, 15 cases(88%) within 24 hours.
In the blunt trauma, the herniated organs into the thorax were stomach(7), omentum(6), spleen(6), liver(5), colon(4), small bowel(2) and in the penetrating, stomach(7), colon(6), omentum(3), liver(2), and spleen(1) were herniated.
Injury severity score(ISS) of 35-blunt trauma ranged from 11 to 66 with mean value of
30.6. Mean ISS of survivors and nonsurvivors was 27.6 and 52.7 respectively.
The diaphrahmatic repair of 49 cases was performed with thoracic approach in 23 cases, thoracoabdominal approach in 7 cases and abdominal approach in 19 cases, and 3 cases were not operated.
The postoperative complication and mortality were developed in 16 out of 49 cases(33% ) and in 5 cases(9.6%) respectively, and the causes of death were hypovolemic shock(1), combined head injury(2), asphyxia(1), and pulmonary edema and renal failure(1).
In conclusion, the injuries of the diaphragm should be suspected in all patients with severe blunt trauma or penetrating injuries at thorax and upper abdominal area near the diaphragm. All of the cases had associated injury and most of deaths were related to the severity of associated injuries.
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| Key words:
Traumatic, Injury, Diaphragm |
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