Ulus Travma Acil Cerrahi Derg. 2009; 15(1): 71-76

Travmalý hastalarýn deðerlendirilmesinde akýlda tutulmasý gereken taný: Diyafram yýrtýðýq

Maruf Þanlý, Ahmet Feridun Iþýk, Bülent Tunçözgür, Fatih Meteroðlu, Levent Elbeyli
Gaziantep Üniversitesi, Týp Fakültesi, Göðüs Cerrahisi Ana Bilim Dalý, Gaziantep

AMAÇ: Travmatik diyafram yýrtýðý (DY) olgularý deðerlendirildi; taný zorluðu ve tanýdaki gecikmenin önemi vurgulandý, tedavi yöntemi ve sonuçlarý irdelendi. GEREÇ VE YÖNTEM: Cerrahi uygulanan travmatik DY’li 13 hasta (11 erkek, 2 kadýn; ort. yaþ 34,6; daðýlým 7-52 yaþ) demografik özellikler, travma þekli ve zamaný, bulgular, taný yöntemleri, yerleþim, cerrahi tedavi, morbidite ve mortalite yönünden deðerlendirildi. BULGULAR: Travma, olgularýn sekizinde (%61,6) künt, beþinde (%38,4) penetran þekildeydi. Radyolojik olarak 11 olguda karýn içi organlarýn toraks içine doðru yer deðiþtirdiði saptandý. Taný konma süresi altý olguda (%46,1) 2-20 yýl arasýnda deðiþiyordu. Bunlarýn üçü penetran, üçü künt travma grubundaydý. Üç olguda ek organ yaralanmalarý nedeniyle baþka bir merkezde yapýlan torakotomi ve laparotomiye raðmen taný atlanmýþtý. Yýrtýk yeri 12 olguda sol, bir olguda sað hemidiyaframdaydý. Tüm olgulara torakotomi ile yaklaþýlarak primer onarým yapýldý. Ameliyat sonrasý bir olguda morbidite geliþirken, mortalite izlenmedi. SONUÇ: Travmalý hastada akut dönemde kolaylýkla atlanabilmesi nedeniyle DY þüphesi akýlda tutulmalý, eþlik eden patolojiler nedeniyle yapýlan torakotomi ve laparotomilerde diyafram dikkatli þekilde incelenmelidir. Gecikmiþ taný morbidite ve mortaliteyi arttýracaktýr.

Anahtar Kelimeler: Diyafram yýrtýðý; gecikmiþ taný; torakotomi; travma.

---

Diagnosis that should be remembered during evaluation of trauma patients: diaphragmatic rupture

Maruf Þanlý, Ahmet Feridun Iþýk, Bülent Tunçözgür, Fatih Meteroðlu, Levent Elbeyli
Gaziantep University, Medical School, Thoracic Surgery Department, Gaziantep

BACKGROUND: We aimed to emphasize the importance of delay in diagnosis of traumatic diaphragmatic ruptures and to investigate the results of treatment methods. METHODS: The records of 13 patients (11 males, 2 females; mean age 34.6; range 7 to 52 years) with traumatic diaphragmatic ruptures were evaluated with respect to demographic data, type and time of trauma, symptoms, diagnostic methods, localization, surgical therapy, morbidity and mortality. RESULTS:
Blunt trauma was present in 8 cases (61.6%) and penetrating trauma in 5. Migration of abdominal organs into hemithorax was detected in 11 cases radiologically. The duration between diagnosis and the event was 2-20 years in 6 patients (46.1%). Three of them were penetrating and 3 were blunt trauma. In 3 cases, diagnosis had been overlooked despite exploratory thoracotomy and laparotomy in another center. Right hemi-diaphragm was injured in 1 patient and the left in 12 cases. Primary repair through posterolateral thoracotomy was performed in all cases. Morbidity occurred in 1 patient. No mortality was observed. CONCLUSION: Diaphragmatic ruptures should be remembered in trauma cases because of the probability of their being missed, and ruptures should be explored during thoracotomy or laparotomy performed for other organ injuries. Delayed diagnosis will increase morbidity and mortality.

Keywords: Diaphragmatic rupture; delayed diagnosis; thoracotomy; trauma.

---

ATIF KOPYALA