Diaphragmatic Injury in Multisystem Closed Abdominal Trauma: Features of Diagnosis and Treatment

Abstract

INTRODUCTION In connection with the increase in the number of cases of combined and multiple injuries among the population, a proportional increase in the number of cases of diaphragm injury is also observed. In this case, shock is observed, damage to the organs of the chest and abdomen prevails in the absence of strictly specifi c clinical symptoms of diaphragm rupture, which leads to a large percentage of medical and diagnostic errors and complications. The described diffi culties in diagnosing cases of diaphragm injury dictate the need to develop a standardized approach to the management of this category of patients.AIM OF STUDY Refi nement of the treatment and diagnostic approach to the management of patients with concomitant blunt trauma and diaphragm injury from the view of modern diagnostic and surgical technologies.MATERIAL AND METHODS The literature review presents materials of domestic and foreign publications for the period from January 2015 to December 2020, obtained from electronic databases of medical literature PubMed, Cochrane Library, Scopus, eLibrary using the primary search strategy for the following search queries: diaphragm damage, diaphragm rupture, multisystem injury of the chest and abdomen, tactics of multi-stage surgical treatment, closed abdominal trauma, treatment and diagnostic algorithm, thoracoscopy, thoracotomy, laparoscopy, laparotomy (total 308 publications), with subsequent exclusion of experimental studies, non-full-text articles, publications not in Russian or English, manuscripts on open trauma and post-traumatic diaphragmatic hernia older than 30 days old from the moment of injury. The data extraction method was performed by two researchers independently of each other. The analysis was made of multicenter studies, systematic reviews, large case series, original articles (14 retrospective selective studies from 1994 to 2018; a total of 928 patients with closed diaphragmatic injury) and one meta-analysis (2023 patients).RESULTS The treatment and diagnostic algorithm for multisystem closed diaphragmatic injury has been standardized based on the hemodynamic status of the patient, the indications for minimally invasive and open interventions in this category of patients have been clarifi ed, and a description of the staged surgical treatment has been given.CONCLUSION Timely diagnosis, minimally invasive interventions in the treatment of diaphragmatic injuries, as well as their stage-by-stage organization in conditions of severe polytrauma contribute to a decrease in mortality.

Keywords

• closed abdominal trauma
• multisystem injury
• closed diaphragmatic injury
• diaphragm rupture
• laparoscopy
• thoracoscopy
• tactics of multi-stage surgical treatment