KÜNT DÝAFRAGMA YARALANMALARI

1985-1995 tarihleri arasýnda 10 yýllýk süre içinde, Dicle Üniversitesi Týp Fakültesi Genel Cerrahi Kliniðinde, 18 künt diafragma yaralanmalý hasta tedavi edildi. Travma sebebi 14 olguda trafik kazasý, 4 hastada yüksekten düþmeydi. Tüm hastalar akut dönemde görüldü. En sýk rastlanan þikayetler ve fizik bulgular dispne, göðüs aðrýsý, abdominal distansiyon ve solunum seslerinin alýnamamasýydý. AÇ grafiðinde ise, en sýk diafragma gölgesinin kaybolmasý, diafragmanýn elevasyonu ve toraksa visseral herniasyon bulgularýyla karþýlaþýldý. Bu bulgulara göre, olgularýn 11 'inde doðru taný preoperatif dönemde kondu. Tüm hastalar baþvurduklarý gün operasyona alýndýlar. Laparotomide 13 olguda sol, 5 olguda sað diafragma rüptürü saptandý. Dört olguda toraksa herniasyon vardý, ancak strangülasyon yoktu. On olguda diafragma yaralanmasýna intraabdominal organ yaralanmalarý da eslik ediyordu. Sekiz olguda ise, izole diafragma rüptürü saptandý. Kunt diafragma yaralanmasýna en sýk eþlik eden organ dalak idi. Tüm olgularda, diafragma nonabsorbabl sütürlerle iki kat üzerinden tamir edildi. Mortalite oranýmýz eþlik eden travmalara baðlý olarak %16.6 idi. Bu çalýþma bize kunt diafragma yaralanmalarýnýn ender görüldüðü için, tanýda güçlük çekilebilen bir yaralanma olduðunu göstermiþtir. Üst batýna ve göðüse ait künt travmalarda, taný genellikle akut dönemde hastanýn deðerlendirilmesi sýrasýnda, bir künt diafragma yaralanmasý olabileceði þüphesi, operasyonda diafragmatik yüzeyin iyi bir þekilde eksplorasyonu ve posttravmatik dönemde çekilen seri göðüs grafilerin incelenmesiyle konur. Kunt diafragma yaralanmalarýnda prognoz, eþlik eden yaralanmalarýn ciddiyeti ve geç baþvurudan doðan bir takým problemlere baðlýdýr.

BLUNT DIAPHRAGMATIC INJURIES

In a 10 year period, between 1985 to 1995, 18 patients with blunt traumatic rupture of diaphragm were treated in Dicle University General Surgery Department. Causes of trauma were motor vehicle accident in 14 and falling down in 4 cases. All patients were seen within in acute stage. The most frequent complaints and physical findings were dyspnea, chest pain, abdominal distention and absent breath sounds. The most frequent radiographic findings were obscuration of the diaphragmatic shadow, elevation of the diaphragm and visceral herniation to the chest. On the basis of these findings, correct diagnosis was made on 11 patients preoperatively. All patients were treated by laparotomi on the day of admission. At laparotomi, left hemidiaphragm was involved in 13 and the right in 5 patients. There were visceral herniation in 4 patients but not strangulation. Significant intraabdominal injury requiring repair was found in 10 and, isolated injuries of diaphragm was detected in 8 patients. The most frequently injured abdominal viscus was spleen. Repair was always carried out with interrupted sutures with nonabsorbable suture material. The mortality was 16.6%, all attributable to associated injuries or their sequelae. This study suggest that blunt traumatic rupture of diaphragm is an uncommon injury which may be difficult to diagnose. Most cases with severe blunt injuries to the upper abdomen and/or chest will be diagnosed by maintaining a high index of suspicion during the initial assesment and operative exploration of diaphragmatic surface and by performing serial chest radiographs during post-traumatic period. Prognosis of blunt diaphragmatic injuries are due to severity of accompanial injuries and due to the delay between time of injury and administration of patient to the hospital.