A 6-year experience with 16 patients with acute diaphragmatic injuries is reviewed at Su g-Ae General Hospital from April 1985 to April 1991.
@ES The results are as follows;
@EN 1) Of the 16 patients, 13(81.3%) were male and 3 were female(M : F=4.3 : 1).
Age varied from 14 years to 72 years with three fourths occuring in the second, third, fourth decades.
2) Of the 16 patients, 9 had blunt injuries(56.3%) and 7 suffered penetrating trauma.
In the blunt category, motor-vehicle accidents were responsible for all but one injury, which resulted from crush by a heavy object. The later group consisted of stab injuries and gimlet injury.
3) 6 patients and isolated right hemidiaphragm injury(37.5%), and 10 patients had left side injury(62.5%).
4) Of the 16 patients, chest X-ray revealed hemo- and/or pneumothorax in 7 patients(43.8%), herniated abdominal contents were seen in 6 patients(37.5%), elevation of diaphragm was seen in 2 of 9 with blunt trauma patients, and one of 7 patients
with
penetrating injury of diaphragm was interpreted as normal on chest X-ray.
5) Fifteen of the 16 patients were operated on within 24 hours(93.7%). One patient was hospitalized after blunt trauma 2 months.
6) The most common indication for operation was herniation of the intra-abdominal viscera 6 of the 16 patients(37.5%).
7) Of the 16 patients, 9 had a laparotomy(56.3%), 2 had a thoracotomy(12.5%) and 5 had a thoracoabdominal approach(31.3%). All patients were operated in traumatic phase.
8) Common size of injury range 6 to 15 cm in all blunt trauma patients and less than 5 cm in penotrating type wounds.
9) Herniated intra-abdominal contents through the injured diaphragm were observed in 6 patients(37.5%). 5 had blunt trauma and one had penetrating injury. The stomach and spleen were the organs most commonly fond within the chest.
10) Associated injuries occured in 13 patients(81.3%): intra-abdominal injury in 8(50%), thoracic injury in 10(62.5%), fracture in 7(43.8%).
11) The most common intra-abdominal organ involved was the liver(6 of 8 patients, 75%), Hemo- and/or pneumothorax was the most frequent among thoracic injuries(7 of 10 patients, 70%). The pelvic bone was the most common fracture site(3 of 7
patients,
43%).
12) Of the 16 patients, 3 was died(18.8%) from aortic aneurysmal rupture, pulmonary embolism, sepsis due to strangulated intestinal obstruction.
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