Penetrating left thoracoabdominal trauma

The incidence and clinical presentation of diaphragm injuries

J. A. Murray, D. Demetriades, E. E. Cornwell, Juan A. Asensio, G. Velmahos, H. Belzberg, T. V. Berne

Research output: Contribution to journalArticle

93 Citations (Scopus)

Abstract

Objective: The objective of this study was to (1) determine the incidence of diaphragmatic injuries in penetrating left thoracoabdominal trauma and (2) evaluate the role of laparoscopy in detecting clinically occult diaphragmatic injuries. Patients and Methods: One hundred nineteen consecutive patients with penetrating injuries to the left thoracoabdominal region presenting to Los Angeles County-University of Southern California Medical Center were prospectively evaluated during an 8-month period. Either celiotomy (with hemodynamic instability or peritonitis) or laparoscopy was performed. Results of the clinical examination and roentgenographic findings were recorded preoperatively. Results: One hundred seven patients were fully evaluated. Fifty patients required emergent celiotomy. Fifty-seven patients underwent laparoscopy. The overall incidence of diaphragmatic injuries was 42% (59% for gunshot wounds, 32% for stab wounds). Among the 45 patients with diaphragmatic injuries, 31% had no abdominal tenderness, 40% had a normal chest roentgenogram, and 49% had an associated hemopneumothorax. Fifteen of the patients undergoing laparoscopy (26%) had occult diaphragm injuries. Conclusion: (1) The incidence of diaphragmatic injuries in association with penetrating left thoracoabdominal trauma is high. (2) The clinical and roentgenographic findings are unreliable at detecting occult diaphragmatic injuries. (3) Laparoscopy is a vital tool for detecting occult diaphragmatic injuries among patients who have no other indications for formal celiotomy.

Original languageEnglish
Pages (from-to)624-626
Number of pages3
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume43
Issue number4
DOIs
StatePublished - Oct 1997
Externally publishedYes

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Diaphragm
Incidence
Wounds and Injuries
Laparoscopy
Hemopneumothorax
Stab Wounds
Gunshot Wounds
Los Angeles
Peritonitis
Thorax
Hemodynamics

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Penetrating left thoracoabdominal trauma : The incidence and clinical presentation of diaphragm injuries. / Murray, J. A.; Demetriades, D.; Cornwell, E. E.; Asensio, Juan A.; Velmahos, G.; Belzberg, H.; Berne, T. V.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 43, No. 4, 10.1997, p. 624-626.

Research output: Contribution to journalArticle

Murray, J. A. ; Demetriades, D. ; Cornwell, E. E. ; Asensio, Juan A. ; Velmahos, G. ; Belzberg, H. ; Berne, T. V. / Penetrating left thoracoabdominal trauma : The incidence and clinical presentation of diaphragm injuries. In: Journal of Trauma - Injury, Infection and Critical Care. 1997 ; Vol. 43, No. 4. pp. 624-626.
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abstract = "Objective: The objective of this study was to (1) determine the incidence of diaphragmatic injuries in penetrating left thoracoabdominal trauma and (2) evaluate the role of laparoscopy in detecting clinically occult diaphragmatic injuries. Patients and Methods: One hundred nineteen consecutive patients with penetrating injuries to the left thoracoabdominal region presenting to Los Angeles County-University of Southern California Medical Center were prospectively evaluated during an 8-month period. Either celiotomy (with hemodynamic instability or peritonitis) or laparoscopy was performed. Results of the clinical examination and roentgenographic findings were recorded preoperatively. Results: One hundred seven patients were fully evaluated. Fifty patients required emergent celiotomy. Fifty-seven patients underwent laparoscopy. The overall incidence of diaphragmatic injuries was 42{\%} (59{\%} for gunshot wounds, 32{\%} for stab wounds). Among the 45 patients with diaphragmatic injuries, 31{\%} had no abdominal tenderness, 40{\%} had a normal chest roentgenogram, and 49{\%} had an associated hemopneumothorax. Fifteen of the patients undergoing laparoscopy (26{\%}) had occult diaphragm injuries. Conclusion: (1) The incidence of diaphragmatic injuries in association with penetrating left thoracoabdominal trauma is high. (2) The clinical and roentgenographic findings are unreliable at detecting occult diaphragmatic injuries. (3) Laparoscopy is a vital tool for detecting occult diaphragmatic injuries among patients who have no other indications for formal celiotomy.",
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