Ulus Travma Acil Cerrahi Derg. 2011; 17(5): 435-439 | DOI: 10.5505/tjtes.2011.89804

Geç bulgu veren travmatik diyafram hernileri

Ismail Okan¹, Gurhan Bas², Sedat Ziyade³, Orhan Alimoglu², Ramazan Eryilmaz², Deniz Guzey², Aydin Zilan^2
1Gaziosmanpaþa Üniversitesi, Týp Fakültesi, Genel Cerrahi Ana Bilim Dalý, Tokat
²Vakýf Gureba Eðitim Ve Araþtýrma Hastanesi, Genel Cerrahi Servisi, Istanbul
³Vakýf Gureba Eðitim Ve Araþtýrma Hastanesi, Göðüs Cerrahisi Servisi, Istanbul

AMAÇ
Travma sonrasý gözden kaçan diyafram yaralanmalarý karýn içi organlarýn toraksa fýtýklaþmasý ile sonuçlanabilir. Bu çalýþmada, travma sonrasý gecikmiþ diyafram yaralanmasý nedeniyle tedavi edilen hastalar deðerlendirildi.
GEREÇ VE YÖNTEM
2001-2009 yýllarý arasýnda travma sonrasý geç bulgu veren diyafram hernisi tanýsý alan hastalarýn dosyalarý geriye dönük olarak incelendi.
BULGULAR
Çalýþmaya alýnan 10 hastanýn yaþ ortalamasý 44,3 yýl idi. Hastalarýn altýsý kadýndý. Etyolojide künt travma daha sýk (n=7) olarak saptandý. Travma ile travma sonrasý diyafram hernisi tanýsýyla hastaneye baþvuru arasýnda geçen süre ortalama 5,9 yýl (4 ay-19 yýl) idi. Dokuz hastada diyafram hernisi soldaydý. Tüm hastalarýn arka-ön akciðer grafisi çekildi ve çoðunda sadece grafi ile taný kondu (n=8). Yedi hastada ilave olarak bilgisayarlý tomografi ve manyetik rezonans görüntüleme kullanýldý. Herni tamiri için yedi hastada laparotomi iki hastada torakotomi yapýlýrken, bir hastada sol torakoabdominal insizyon kullanýldý. Onarým için yedi hastada yama kullanýldý. Ameliyat sonrasý ortalama hastanede kalýþ süresi 10,6 gündü. Bir hastada ampiyem ve atelektazi saptandý. Ameliyat sonrasý mortalite saptanmadý.
SONUÇ
Travma sonrasý geç bulgu veren diyafram hernisi travma cerrahlarý için ciddi bir problemdir. Taný ve tedavinin doðru ve hýzlý uygulanmasý fýtýklaþmýþ organlarýn perforasyon veya gangreni sonrasý geliþebilecek morbidite ve mortaliteyi engeller.

Anahtar Kelimeler: Diyafram hernisi, gecikmiþ taný; travma sonrasý; travmatik diyafram yaralanmasý.

---

Delayed presentation of posttraumatic diaphragmatic hernia

Ismail Okan¹, Gurhan Bas², Sedat Ziyade³, Orhan Alimoglu², Ramazan Eryilmaz², Deniz Guzey², Aydin Zilan^2
1Department Of General Surgery, Faculty Of Medicine, Gaziosmanpasa University, Tokat
²Department Of General Surgery, Vakif Gureba Training And Research Hospital, Istanbul
³Department Of Thoracic Surgery, Vakif Gureba Training And Research Hospital, Istanbul

BACKGROUND
Missed diaphragmatic injuries after trauma may present with herniation of intraabdominal organs into the thoracic cavity. We aimed to review our patients who presented with delayed posttraumatic diaphragmatic hernia.
METHODS
A retrospective review of the medical records of patients with delayed diagnosis of posttraumatic diaphragmatic hernia between 2001 and 2009 was performed.
RESULTS
Ten patients with a mean age of 44.3 years were included. Six patients were female. Blunt injuries (n: 7) were more common. Mean duration between trauma and presentation to the hospital was 5.9 years (4 months - 19 years). Nine patients had left-sided diaphragmatic hernia. All patients had chest X-ray and most were diagnostic (n: 8). Additional diagnostic imaging with computerized tomography (CT) and magnetic resonance (MR) was used in seven patients. For the repair, laparotomy incision was chosen for seven patients and thoracotomy incision for two patients. One patient underwent left thoracoabdominal approach. Mesh repair was used in seven patients. Postoperative mean hospitalization was 10.6 days. Empyema and atelectasis were the morbidities in one patient. No postoperative mortality was detected.
CONCLUSION
Delayed presentation of posttraumatic diaphragmatic hernia is a serious challenge for trauma surgeons. Prompt diagnosis and treatment prevent serious morbidity and mortality associated with complications such as gangrene and/or perforation of the herniated organ.

Keywords: Diaphragmatic hernia, delayed presentation; posttraumatic; traumatic diaphragmatic injury.

---

ATIF KOPYALA