Mınımum Nassıve Approach to Post-Traumıc Dıaphragm Injury

Abstract

Objectıves: Diaphragm injury is mostly caused by blunt or penetrating trauma. It is a rare diagnosis and therefore carries a risk of misdiagnosis or delay in diagnosis. We perform routine thoracoscopy for the treatment of patients with traumatic rib fractures in our institution. We recorded several cases of occult diaphragmatic injuries and hypothesized that these injuries may be a penetrating injury from rib fractures, as opposed to the high-velocity blunt trauma typically associated with diaphragmatic injuries.

Methods: The medical records of all patients admitted to our Şişli etfal hamdiye hospital with rib fractures and traumatic diaphragmatic injuries between January 2012 and January 2023 were retrospectively reviewed.

Results: During the study period, 2218 patients had rib fractures and 68 of them had diaphragmatic injuries. 26 patients with traumatic diaphragmatic injuries were found to have been operated by thoracic surgeons. After the video-assisted thoracoscopic surgical evaluation of the pleural space, surgery was performed in 11 patients who were diagnosed with diaphragmatic injury intraoperatively.

Conclusıons: Our patient series illustrates the diagnostic difficulties in determining the association and condition between major rib fractures and diaphragmatic injuries in trauma patients. We recommend using a thoracoscope in patients undergoing post-traumatic chest wall surgery to aid in the diagnosis of this condition.