Occult injuries to the diaphragm

Prospective evaluation of laparoscopy in penetrating injuries to the left lower chest

James A. Murray, Demetrios Demetriades, Juan A. Asensio, Edward E. Cornwell, George C. Velmahos, Howard Belzberg, Thomas V. Berne

Research output: Contribution to journalArticle

131 Citations (Scopus)

Abstract

Background: To evaluate the incidence of occult diaphragmatic injuries and investigate the role of laparoscopy in patients with penetrating trauma to the left lower chest who lack indications for exploratory celiotomy other than the potential for a diaphragm injury. Study Design: Patients 'with penetrating injuries to the left lower chest who were hemodynamically stable and without indications for a celiotomy were prospectively evaluated with diagnostic laparoscopy to determine the presence of an injury to the left hemidiaphragm. Diagnostic laparoscopy was performed in the operating room under general anesthesia. Results: One-hundred-ten patients (94 stab wounds, 16 gunshot wounds) were evaluated with laparoscopy. Twenty-six (24%) diaphragmatic injuries were identified (26% for stab wounds and 13% for gunshot wounds). Comparison of patients with diaphragmatic injuries with those without diaphragmatic injuries demonstrated a slightly greater incidence of hemo/pneumothoraces (35% versus 24%, NS). The incidence of diaphragmatic injuries in patients with a normal chest x-ray was 21% versus 31% for patients with a hemo/pneumothorax. An elevated left hemidiaphragm was associated with a diaphragmatic injuries in only 1 of 7 patients (14%). The incidence of diaphragmatic injuries was similar for anterior, lateral, and posterior injuries (22%, 27%, and 22% respectively). Conclusions: The incidence of occult diaphragmatic injuries in penetrating trauma to the left lower chest is high, 24%. These injuries are associated with a lack of clinical and radiographic findings, and would have been missed had laparoscopy not been performed. Patients with penetrating trauma to the left lower chest who do not have any other indication for a celiotomy should undergo videoscopic evaluation of the left hemidiaphragm to exclude an occult injury.

Original languageEnglish
Pages (from-to)626-630
Number of pages5
JournalJournal of the American College of Surgeons
Volume187
Issue number6
DOIs
StatePublished - 1998
Externally publishedYes

Fingerprint

Diaphragm
Laparoscopy
Thorax
Wounds and Injuries
Incidence
Stab Wounds
Gunshot Wounds
Pneumothorax
Operating Rooms
General Anesthesia

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Occult injuries to the diaphragm : Prospective evaluation of laparoscopy in penetrating injuries to the left lower chest. / Murray, James A.; Demetriades, Demetrios; Asensio, Juan A.; Cornwell, Edward E.; Velmahos, George C.; Belzberg, Howard; Berne, Thomas V.

In: Journal of the American College of Surgeons, Vol. 187, No. 6, 1998, p. 626-630.

Research output: Contribution to journalArticle

Murray, James A. ; Demetriades, Demetrios ; Asensio, Juan A. ; Cornwell, Edward E. ; Velmahos, George C. ; Belzberg, Howard ; Berne, Thomas V. / Occult injuries to the diaphragm : Prospective evaluation of laparoscopy in penetrating injuries to the left lower chest. In: Journal of the American College of Surgeons. 1998 ; Vol. 187, No. 6. pp. 626-630.
@article{429de0f5146c4570882ac60f55e0189d,
title = "Occult injuries to the diaphragm: Prospective evaluation of laparoscopy in penetrating injuries to the left lower chest",
abstract = "Background: To evaluate the incidence of occult diaphragmatic injuries and investigate the role of laparoscopy in patients with penetrating trauma to the left lower chest who lack indications for exploratory celiotomy other than the potential for a diaphragm injury. Study Design: Patients 'with penetrating injuries to the left lower chest who were hemodynamically stable and without indications for a celiotomy were prospectively evaluated with diagnostic laparoscopy to determine the presence of an injury to the left hemidiaphragm. Diagnostic laparoscopy was performed in the operating room under general anesthesia. Results: One-hundred-ten patients (94 stab wounds, 16 gunshot wounds) were evaluated with laparoscopy. Twenty-six (24{\%}) diaphragmatic injuries were identified (26{\%} for stab wounds and 13{\%} for gunshot wounds). Comparison of patients with diaphragmatic injuries with those without diaphragmatic injuries demonstrated a slightly greater incidence of hemo/pneumothoraces (35{\%} versus 24{\%}, NS). The incidence of diaphragmatic injuries in patients with a normal chest x-ray was 21{\%} versus 31{\%} for patients with a hemo/pneumothorax. An elevated left hemidiaphragm was associated with a diaphragmatic injuries in only 1 of 7 patients (14{\%}). The incidence of diaphragmatic injuries was similar for anterior, lateral, and posterior injuries (22{\%}, 27{\%}, and 22{\%} respectively). Conclusions: The incidence of occult diaphragmatic injuries in penetrating trauma to the left lower chest is high, 24{\%}. These injuries are associated with a lack of clinical and radiographic findings, and would have been missed had laparoscopy not been performed. Patients with penetrating trauma to the left lower chest who do not have any other indication for a celiotomy should undergo videoscopic evaluation of the left hemidiaphragm to exclude an occult injury.",
author = "Murray, {James A.} and Demetrios Demetriades and Asensio, {Juan A.} and Cornwell, {Edward E.} and Velmahos, {George C.} and Howard Belzberg and Berne, {Thomas V.}",
year = "1998",
doi = "10.1016/S1072-7515(98)00246-4",
language = "English",
volume = "187",
pages = "626--630",
journal = "Journal of the American College of Surgeons",
issn = "1072-7515",
publisher = "Elsevier Inc.",
number = "6",

}

TY - JOUR

T1 - Occult injuries to the diaphragm

T2 - Prospective evaluation of laparoscopy in penetrating injuries to the left lower chest

AU - Murray, James A.

AU - Demetriades, Demetrios

AU - Asensio, Juan A.

AU - Cornwell, Edward E.

AU - Velmahos, George C.

AU - Belzberg, Howard

AU - Berne, Thomas V.

PY - 1998

Y1 - 1998

N2 - Background: To evaluate the incidence of occult diaphragmatic injuries and investigate the role of laparoscopy in patients with penetrating trauma to the left lower chest who lack indications for exploratory celiotomy other than the potential for a diaphragm injury. Study Design: Patients 'with penetrating injuries to the left lower chest who were hemodynamically stable and without indications for a celiotomy were prospectively evaluated with diagnostic laparoscopy to determine the presence of an injury to the left hemidiaphragm. Diagnostic laparoscopy was performed in the operating room under general anesthesia. Results: One-hundred-ten patients (94 stab wounds, 16 gunshot wounds) were evaluated with laparoscopy. Twenty-six (24%) diaphragmatic injuries were identified (26% for stab wounds and 13% for gunshot wounds). Comparison of patients with diaphragmatic injuries with those without diaphragmatic injuries demonstrated a slightly greater incidence of hemo/pneumothoraces (35% versus 24%, NS). The incidence of diaphragmatic injuries in patients with a normal chest x-ray was 21% versus 31% for patients with a hemo/pneumothorax. An elevated left hemidiaphragm was associated with a diaphragmatic injuries in only 1 of 7 patients (14%). The incidence of diaphragmatic injuries was similar for anterior, lateral, and posterior injuries (22%, 27%, and 22% respectively). Conclusions: The incidence of occult diaphragmatic injuries in penetrating trauma to the left lower chest is high, 24%. These injuries are associated with a lack of clinical and radiographic findings, and would have been missed had laparoscopy not been performed. Patients with penetrating trauma to the left lower chest who do not have any other indication for a celiotomy should undergo videoscopic evaluation of the left hemidiaphragm to exclude an occult injury.

AB - Background: To evaluate the incidence of occult diaphragmatic injuries and investigate the role of laparoscopy in patients with penetrating trauma to the left lower chest who lack indications for exploratory celiotomy other than the potential for a diaphragm injury. Study Design: Patients 'with penetrating injuries to the left lower chest who were hemodynamically stable and without indications for a celiotomy were prospectively evaluated with diagnostic laparoscopy to determine the presence of an injury to the left hemidiaphragm. Diagnostic laparoscopy was performed in the operating room under general anesthesia. Results: One-hundred-ten patients (94 stab wounds, 16 gunshot wounds) were evaluated with laparoscopy. Twenty-six (24%) diaphragmatic injuries were identified (26% for stab wounds and 13% for gunshot wounds). Comparison of patients with diaphragmatic injuries with those without diaphragmatic injuries demonstrated a slightly greater incidence of hemo/pneumothoraces (35% versus 24%, NS). The incidence of diaphragmatic injuries in patients with a normal chest x-ray was 21% versus 31% for patients with a hemo/pneumothorax. An elevated left hemidiaphragm was associated with a diaphragmatic injuries in only 1 of 7 patients (14%). The incidence of diaphragmatic injuries was similar for anterior, lateral, and posterior injuries (22%, 27%, and 22% respectively). Conclusions: The incidence of occult diaphragmatic injuries in penetrating trauma to the left lower chest is high, 24%. These injuries are associated with a lack of clinical and radiographic findings, and would have been missed had laparoscopy not been performed. Patients with penetrating trauma to the left lower chest who do not have any other indication for a celiotomy should undergo videoscopic evaluation of the left hemidiaphragm to exclude an occult injury.

UR - http://www.scopus.com/inward/record.url?scp=0031792923&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031792923&partnerID=8YFLogxK

U2 - 10.1016/S1072-7515(98)00246-4

DO - 10.1016/S1072-7515(98)00246-4

M3 - Article

VL - 187

SP - 626

EP - 630

JO - Journal of the American College of Surgeons

JF - Journal of the American College of Surgeons

SN - 1072-7515

IS - 6

ER -