Вестник хирургии имени И.И. Грекова (Sep 2022)

Traumatic diaphragmatic hernias in patients with closed chest and abdominal trauma

  • V. P. Bykov,
  • K. O. Pavlov,
  • E. A. Mordovskii,
  • V. F. Fedoseev,
  • A. P. Korobitsyn,
  • A. A. Beliaev,
  • G. M. Karelskii

DOI
https://doi.org/10.24884/0042-4625-2022-181-1-73-79
Journal volume & issue
Vol. 181, no. 1
pp. 73 – 79

Abstract

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The OBJECTIVE of the study was the pathomorphological features, diagnosis, and treatment outcomes of diaphragm ruptures in closed trunk trauma.MATERIALS AND METHODS. We prospectively studied diaphragmatic ruptures in 35 hospitalized patients with blunt trunk trauma and diaphragmatic defects in 9 patients with chronic traumatic diaphragmatic hernia, previously not recognized in other hospitals. Damage severity was assessed using the MFS-D (MI) scale; statistical data were processed using the WinPepi program: calculation of the boundaries of 95 % CI of medium and extensive values using the fisher method.RESULTS. Diaphragmatic ruptures were observed in 3.25 % of the victims. Damage to the left side occurred 2.4 times more often than the right side; on the left, they were mainly localized in the lumbar and adjacent costal parts. The average length of the rupture of the right half was 13.5, the left half was 9.8 (2-25) cm. More often, the greater omentum, colon, liver and stomach fell into the pleural cavity. During the first day, 2/3 of diaphragm ruptures were diagnosed, mainly during thoracotomy and laparotomy due to bleeding. Missing a rupture of the left half of the diaphragm was allowed at 6 laparotomies. Mortality rate was 31.4 %, the main causes were acute blood loss, severe brain damage; 2 out of 11 deaths were due to a complicated course of an unrecognized diaphragmatic rupture. All patients with chronic diaphragmatic hernia recovered after surgery.CONCLUSION. Diagnosis of diaphragmatic rupture in severe trunk injury on the first day is difficult, radiation methods: radiography, MSCT, ultrasound are not informative enough. When performing diagnostic studies and abdominal operations, it is necessary to study the diaphragm. Repeated survey radiography and MSCT of the chest during the first three weeks of inpatient treatment of the victim increases the detection of acute traumatic diaphragmatic hernia.

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