Cargando…

Traumatic diaphragmatic injuries: epidemiological, diagnostic and therapeutic aspects

INTRODUCTION: Diaphragmatic injuries include wounds and diaphragm ruptures, due to a thoracoabdominal blunt or penetrating traumas. Their incidence ranges between 0.8 and 15 %. The diagnosis is often delayed, despite several medical imaging techniques. The surgical management remains controversal, p...

Descripción completa

Detalles Bibliográficos
Autores principales: Thiam, Ousmane, Konate, Ibrahima, Gueye, Mohamadou Lamine, Toure, Alpha Omar, Seck, Mamadou, Cisse, Mamadou, Diop, Balla, Dirie, Elias Said, Ka, Ousmane, Thiam, Mbaye, Dieng, Madieng, Dia, Abdarahmane, Toure, Cheikh Tidiane
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5028363/
https://www.ncbi.nlm.nih.gov/pubmed/27652187
http://dx.doi.org/10.1186/s40064-016-3291-1
_version_ 1782454355125862400
author Thiam, Ousmane
Konate, Ibrahima
Gueye, Mohamadou Lamine
Toure, Alpha Omar
Seck, Mamadou
Cisse, Mamadou
Diop, Balla
Dirie, Elias Said
Ka, Ousmane
Thiam, Mbaye
Dieng, Madieng
Dia, Abdarahmane
Toure, Cheikh Tidiane
author_facet Thiam, Ousmane
Konate, Ibrahima
Gueye, Mohamadou Lamine
Toure, Alpha Omar
Seck, Mamadou
Cisse, Mamadou
Diop, Balla
Dirie, Elias Said
Ka, Ousmane
Thiam, Mbaye
Dieng, Madieng
Dia, Abdarahmane
Toure, Cheikh Tidiane
author_sort Thiam, Ousmane
collection PubMed
description INTRODUCTION: Diaphragmatic injuries include wounds and diaphragm ruptures, due to a thoracoabdominal blunt or penetrating traumas. Their incidence ranges between 0.8 and 15 %. The diagnosis is often delayed, despite several medical imaging techniques. The surgical management remains controversal, particularly for the choice of the surgical approach and technique. The mortality is mainly related to associated injuries. The aim of our study was to evaluate the incidence of diaphragmatic injuries occuring in thoraco-abdominal traumas, and to discuss their epidemiology, diagnosis and treatment. PATIENTS AND METHODS: We performed a retrospective study over a period of 21 years, between January 1994 and June 2015 at the Department of General Surgery of the Aristide Le Dantec hospital in Dakar, Senegal. All patients diagnosed with diaphragmatic injuries were included in the study. RESULTS: Over the study period, 1535 patients had a thoraco-abdominal trauma. There were 859 cases of blunt trauma, and 676 penetrating chest or abdominal trauma. Our study involved 20 cases of diaphragmatic injuries (1.3 %). The sex-ratio was 4. The mean age was 33 years. Brawls represented 83.3 % (17 cases). Stab attacks represented 60 % (12 cases). The incidence of diaphragmatic injury was 2.6 %. The wound was in the thorax in 60 % (seven cases). Chest radiography was contributory in 45 % (nine cases). The diagnosis of wounds or ruptures of the diaphragm was done preoperatively in 45 % (nine cases). The diaphragmatic wound was on the left side in 90 % (18 cases) and its mean size was 4.3 cm. The surgical procedure involved a reduction of herniated viscera and a suture of the diaphragm by “X” non absorbable points in 85 % (17 cases). A thoracic aspiration was performed in all patients. Morbidity rate was 10 % and mortality rate 5 %. CONCLUSION: The diagnosis of diaphragmatic rupture and wounds remains difficult and often delayed. They should be kept in mind in any blunt or penetrating thoraco-abdominal trauma. Diaphragmatic lesions are usually located on the left side. Surgery is an efficient treatment.
format Online
Article
Text
id pubmed-5028363
institution National Center for Biotechnology Information
language English
publishDate 2016
publisher Springer International Publishing
record_format MEDLINE/PubMed
spelling pubmed-50283632016-09-20 Traumatic diaphragmatic injuries: epidemiological, diagnostic and therapeutic aspects Thiam, Ousmane Konate, Ibrahima Gueye, Mohamadou Lamine Toure, Alpha Omar Seck, Mamadou Cisse, Mamadou Diop, Balla Dirie, Elias Said Ka, Ousmane Thiam, Mbaye Dieng, Madieng Dia, Abdarahmane Toure, Cheikh Tidiane Springerplus Research INTRODUCTION: Diaphragmatic injuries include wounds and diaphragm ruptures, due to a thoracoabdominal blunt or penetrating traumas. Their incidence ranges between 0.8 and 15 %. The diagnosis is often delayed, despite several medical imaging techniques. The surgical management remains controversal, particularly for the choice of the surgical approach and technique. The mortality is mainly related to associated injuries. The aim of our study was to evaluate the incidence of diaphragmatic injuries occuring in thoraco-abdominal traumas, and to discuss their epidemiology, diagnosis and treatment. PATIENTS AND METHODS: We performed a retrospective study over a period of 21 years, between January 1994 and June 2015 at the Department of General Surgery of the Aristide Le Dantec hospital in Dakar, Senegal. All patients diagnosed with diaphragmatic injuries were included in the study. RESULTS: Over the study period, 1535 patients had a thoraco-abdominal trauma. There were 859 cases of blunt trauma, and 676 penetrating chest or abdominal trauma. Our study involved 20 cases of diaphragmatic injuries (1.3 %). The sex-ratio was 4. The mean age was 33 years. Brawls represented 83.3 % (17 cases). Stab attacks represented 60 % (12 cases). The incidence of diaphragmatic injury was 2.6 %. The wound was in the thorax in 60 % (seven cases). Chest radiography was contributory in 45 % (nine cases). The diagnosis of wounds or ruptures of the diaphragm was done preoperatively in 45 % (nine cases). The diaphragmatic wound was on the left side in 90 % (18 cases) and its mean size was 4.3 cm. The surgical procedure involved a reduction of herniated viscera and a suture of the diaphragm by “X” non absorbable points in 85 % (17 cases). A thoracic aspiration was performed in all patients. Morbidity rate was 10 % and mortality rate 5 %. CONCLUSION: The diagnosis of diaphragmatic rupture and wounds remains difficult and often delayed. They should be kept in mind in any blunt or penetrating thoraco-abdominal trauma. Diaphragmatic lesions are usually located on the left side. Surgery is an efficient treatment. Springer International Publishing 2016-09-20 /pmc/articles/PMC5028363/ /pubmed/27652187 http://dx.doi.org/10.1186/s40064-016-3291-1 Text en © The Author(s) 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Research
Thiam, Ousmane
Konate, Ibrahima
Gueye, Mohamadou Lamine
Toure, Alpha Omar
Seck, Mamadou
Cisse, Mamadou
Diop, Balla
Dirie, Elias Said
Ka, Ousmane
Thiam, Mbaye
Dieng, Madieng
Dia, Abdarahmane
Toure, Cheikh Tidiane
Traumatic diaphragmatic injuries: epidemiological, diagnostic and therapeutic aspects
title Traumatic diaphragmatic injuries: epidemiological, diagnostic and therapeutic aspects
title_full Traumatic diaphragmatic injuries: epidemiological, diagnostic and therapeutic aspects
title_fullStr Traumatic diaphragmatic injuries: epidemiological, diagnostic and therapeutic aspects
title_full_unstemmed Traumatic diaphragmatic injuries: epidemiological, diagnostic and therapeutic aspects
title_short Traumatic diaphragmatic injuries: epidemiological, diagnostic and therapeutic aspects
title_sort traumatic diaphragmatic injuries: epidemiological, diagnostic and therapeutic aspects
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5028363/
https://www.ncbi.nlm.nih.gov/pubmed/27652187
http://dx.doi.org/10.1186/s40064-016-3291-1
work_keys_str_mv AT thiamousmane traumaticdiaphragmaticinjuriesepidemiologicaldiagnosticandtherapeuticaspects
AT konateibrahima traumaticdiaphragmaticinjuriesepidemiologicaldiagnosticandtherapeuticaspects
AT gueyemohamadoulamine traumaticdiaphragmaticinjuriesepidemiologicaldiagnosticandtherapeuticaspects
AT tourealphaomar traumaticdiaphragmaticinjuriesepidemiologicaldiagnosticandtherapeuticaspects
AT seckmamadou traumaticdiaphragmaticinjuriesepidemiologicaldiagnosticandtherapeuticaspects
AT cissemamadou traumaticdiaphragmaticinjuriesepidemiologicaldiagnosticandtherapeuticaspects
AT diopballa traumaticdiaphragmaticinjuriesepidemiologicaldiagnosticandtherapeuticaspects
AT dirieeliassaid traumaticdiaphragmaticinjuriesepidemiologicaldiagnosticandtherapeuticaspects
AT kaousmane traumaticdiaphragmaticinjuriesepidemiologicaldiagnosticandtherapeuticaspects
AT thiammbaye traumaticdiaphragmaticinjuriesepidemiologicaldiagnosticandtherapeuticaspects
AT diengmadieng traumaticdiaphragmaticinjuriesepidemiologicaldiagnosticandtherapeuticaspects
AT diaabdarahmane traumaticdiaphragmaticinjuriesepidemiologicaldiagnosticandtherapeuticaspects
AT tourecheikhtidiane traumaticdiaphragmaticinjuriesepidemiologicaldiagnosticandtherapeuticaspects