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Journal of the Korean Society of Traumatology 2004;17(1):67-73.
A Clinical Analysis of Traumatic Diaphragmatic Injury
Yohan Kim, M.D.
Department of Thoracic and Cardiovascular Surgery, School of Medicine, Konkuk University, Chungju, Korea
외상성 횡격막 손상의 임상적 고찰
김요한
건국대학교 의과대학 흉부외과학교실
Abstract
Background: Traumatic diaphragmatic injury is an occult and often dangerous injury which is encountered with increasing frequency as a result of the growing number of traumas. Although rarely lethal, it may threaten life by upsetting cardiorespiratory dynamics or it can cause chronic gastrointestinal symptoms for many months before presenting with obstruction and strangulation. To analyze the clinical and radiological features and the therapeutic implications, a retrospective analysis was performed. Material and Methods: We reviewed the charts and radiographs of 29 patients with traumatic injury of the diaphragm treated in our hospital from 1994 to 2003. Results: This injury affects predominantly males (male:female=21:8) in the third to forth decade of life, and often caused by blunt trauma (86.2%). Traumatic diaphragmatic injurry was left-sided in 25 cases (86%), right-sided in 4 (14%). Preoperative diagnosis was made in 17 cases (58%) and 11 cases were diagnosed intraoperativly. In one case, a left diaphragmatic injury was missed on initial evaluation but became apparent after the other operation. Most common postoperative complication was respiratory failures and all patients were treated by ventilatory supports. There were 4 (13.8%) early hospital deaths because of combined injuries. Conclusions: Uniform diagnosis and treatment depend on a high index of suspicion, careful scrutiny of the chest roentgenogram in patients with thoracoabdominal or multiple trauma, and meticulous inspection of the diaphragm when operating for concurrent injuries.
Key Words: Diaphragm; Trauma


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