This journal only 2009, Number 1 Cir Gen 2009; 31 (1) Diaphragmatic injuries due to blunt trauma. Experience in a trauma center Ferrufino MAL, Vázquez MJC, Delgadillo GS Full text How to cite this article Language: Spanish References: 21 Page: 26-30 PDF size: 240.56 Kb. Key words: Diaphragm, blunt trauma. ABSTRACT Objective: To analyze the prevalence and management of diaphragmatic injuries due to blunt trauma in a trauma-specialized center. Setting: Third level health care hospital. Design: Retrospective, observational, descriptive study. Patients and methods: We reviewed the clinical records of 32 patients with antecedents of thoracoabdominal trauma and diaphragmatic injury, registered in a 7-year period. We analyzed the following variables: gender, age, mechanism and degree of injury, surgical technique used, and morbidity and mortality. All cases were classified according to the diaphragmatic injury scale. Results: We identified 25 men and 7 women with an average age of 41.5 years (16 to 67 years). The injury mechanism was blunt trauma in all patients. Diagnosis was performed transoperatively. Degree III injuries were the most frequent, involving 23 patients, followed by degree II in four patients, and grades I and IV with three and two patients, respectively. Laparotomy was performed in 29 patients and thoracotomy in three. Two-plane surgical repair with continuous suture was used in all cases. Average hospital stay was of 8.5 days (4 to 13 days). Morbidity was of 18.75%. Mortality was of 6.25%, associated to cranioencephalic trauma. Conclusions: Traumatic injury of the diaphragm is not a frequent entity. Its diagnosis requires a high degree of clinical suspicion, based on the injury mechanism. Mortality of diaphragmatic lesions is related with the magnitude of the accompanying injuries. REFERENCES Ward RE, Flynn TC, Clark WP. Diaphragmatic disruption secondary to blunt abdominal trauma. J Trauma 1981; 21: 35-38. Mansour KA. Trauma to the diaphragm. Chest Surg Clin N Am 1997; 7: 373-383. Asencio JA, Rodríguez A, Demetriades D. Injury to the diaphragm. In: Mattox KL, Feliciano DV, Moore EE. Trauma. 4th ed. McGraw-Hill, New York 2000, 603-632. Matsevych OY. Blunt diaphragmatic rupture: four year’s experience. Hernia 2008; 12: 73-78. Adegboye VO, Ladipo JK, Adebo OA, Brimmo AI. Diaphragmatic injuries. Afr J Med Med Sci 2002; 31: 149-153. Leppäniemi A, Haapiainen R. Occult diaphragmatic injuries caused by stab wounds. J Trauma 2003; 55: 646-650. Simpson J, Lobo DN, Shah AB, Rowlands BJ. Traumatic diaphragmatic rupture: associated injuries and outcome. Ann R Coll Surg Engl 2000; 82: 97-100. Meyers BF, McCabe CJ. Traumatic diaphragmatic hernia. Occult marker of serious injury. Ann Surg 1 993; 218: 783-790. Boulanger BR, Milzman DP, Rosati C. Rodríguez A. A comparison of right and left blunt traumatic diaphragmatic rupture. J Trauma 1993; 35: 255-260. .Beal SL, McKennan M. Blunt diaphragmatic rupture. A morbid injury. Arch Surg 1988; 123: 828-832. Aronoff RJ, Reynolds J, Thal ER. Evaluation of diaphragmatic injuries. Am J Surg 1982; 144: 571-575. Ilgenfritz FM, Stewart DE. Blunt trauma of the diaphragm: a 15-county, private hospital experience. Am Surg 1992; 58: 334-339. Moore EE, Malangoni MA, Cogbill TH, Shackford SR, Champion HR, Jurkovich GJ, et al. Organ injury scaling. IV: Thoracic vascular, lung, cardiac, and diaphragm. J Trauma 1994; 36: 299-300. Guth AA, Pachter HL, Kim U. Pitfalls in the diagnosis of blunt diaphragmatic injury. Am J Surg 1995; 170: 5-9. Casanova D, Espadas FI, Quesada A, Martino E, Escalante CF, Díaz-Regañon G. Traumatismos de diafragma. Estudio de 65 casos. Cir Esp 1991; 50: 448-492. Reber PU, Schmied B, Seiler CA, Baer HU, Patel AG, Büchler MW. Missed diaphragmatic injuries and their long-term sequelae. J Trauma 1998; 44: 183-188. Murray JA, Demetriades D, Cornwell EE 3rd , Asensio JA, Velmahos G, Belzberg H, et al. Penetrating left thoracoabdominal trauma: the incidence and clinical presentation of diaphragm injuries. J Trauma 1997; 43: 624-626. Ochoa LLM, Soriano GAP, Lera TJM. Traumatismos diafragmáticos. Rev Esp Enferm Dig 1994; 85: 487-488. Powell BS, Magnotti LJ, Schroeppel TJ, Finnell CW, Savage SA, Fischer PE, et al. Diagnostic laparoscopy for the evaluation of occult diaphragmatic injury following penetrating thoracoabdominal trauma. Injury 2008; 39: 530-534. Bergeron E, Clas D, Ratte S, Beauchamp G, Denis R, Evans D, et al. Impact of deferred treatment of blunt diaphragmatic rupture: a 15-year experience in six trauma centers in Quebec. J Trauma 2002; 52: 633-640. Matthews BD, Bui H, Harold KL, Kercher KW, Adrales G, Park A, et al. Laparoscopic repair of traumatic diaphragmatic injuries. Surg Endosc 2003; 17: 254-258.