TRAUMATIC DIAPHRAGMATIC INJURIES IN CHILDREN

In this study eight children who were treated with diaphragmatic rupture following nonpenetrating trauma between January 1987 and January 1995 were analyzed. There were five girls and three boys, ranging in age from 4 to 13 years (average 9.3 years). Road trauma was the cause in 5 cases and fall from height in 3 patients. The diagnosis of diaphragmatic injury was made radiologically in all patients. The left hemidiaphragm was injured in 7 patients and right hemidiaphragm in one. Clinical examination revealed respiratory distress in 3 patients and diminished breath sounds on the side of the lesion. The most common associated injuries were the extremity fractures. All patients underwent laparotomy with primary repair of the diaphragm. The most frequently herniated organ was the stomach (7 patients). Atelectasis developed in one patient and infection occurred in one patient postoperatively. The mean hospital stay was 16 days (6 to 30 days). There were no deaths in this series.

ÇOCUKLARDA TRAVMATÝK DÝAFRAGMA YARALANMALARI

Kliniðimizde Ocak 1987 ve Ocak 1995 tarihleri arasýnda künt travma sonucu diafragma rüptürü nedeniyle tedavi edilen sekiz hasta retrospektif olarak incelendi. Hastalarýn beþi kýz, üçü erkek olup ortalama yaþlarý 9.3 yaþ (4-13) idi. Beþ hastada trafik kazasý, üç hastada ise yüksekten düþme sonucu diafragma rüptürünün geliþtiði tesbit edildi. Taný tüm hastalarda toraks grafisi ile konuldu. Rüptür yedi hastada sol, bir hastada ise sað tarafta idi. Fizik muayenede üç hastada solunum sýkýntýsý tesbit edildi ve hastalarýn hepsinde rüptüre olan tarafta solunum sesleri azalmýþtý. Multipl travmalý bu hastada ek organ yaralanmasý olarak en sýk ekstremite yaralanmasýnýn bulunduðu (5 hasta) saptandý. Bütün hastalar abdominal yaklaþýmla ameliyat edildi ve bu hastalarda defekt primer onarýldý. Rüptür sonucu en çok midenin (7 hasta) toraksa herniye olduðu tesbit edildi. Ameliyat sonrasý dönemde bir hastada atelektazi ve bir hastada yara enfeksiyonu geliþti. Ortalama hastanede kalýþ süresinin 16 gün (6-30 gün) olarak tesbit edildiði bu seride ölen hasta olmadý.