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急症服务中的急性和迟发性创伤膈肌破裂我们遗漏-SAGEJournals
Hong Kong Journal of Emergency Medicine
Acute and delayed traumatic diaphragmatic ruptures presenting at the
emergency service: what are we missing?
T Alar, E Dedeoglu, T Bulut, MU Yapucu, B Dedeoglu
Introduction: Diaphragmatic rupture is rarely a cause of death by itself. It is especially difficult to diagnose
diaphragmatic ruptures in patients with unstable vital signs who present at the emergency service with
concurrent chest, abdomen, and extremity injuries as a result of blunt trauma. We evaluated the diagnostic
processes, clinical findings and treatment results of acute and delayed traumatic diaphragmatic ruptures
(TDR) cases that presented at the emergency service. Methods: A total of 29 patients that underwent surgical
treatment with a diagnosis of TDR among 102 1 patients that presented at the Canakkale State Hospital
Emergency Service with acute or delayed thoracoabdominal trauma were retrospectively investigated. The
age, gender, trauma etiology, diagnosis duration, injury severity score (ISS), rupture location, accompanying
organ injuries, operation type, inpatient duration, morbidity and mortality were recorded on prepared forms
to analyse the cases. Results: The mean age of the 29 patients with TDR was 45.3 117.76 years with and 20
(69%) males and 9 (3 1%) females. The trauma was blunt in 22 (76%) and penetrating in 7 (24%) cases.
The TDR was acute in 16 (55%) and delayed in 13 (45%) patients. The surgery for TDR treatment consisted
of with thoracotomy in 16 (55%) patients, laparotomy in 11 (38%) patients and both thoracotomy and
laparotomy in 2 (7%) cases . Mortality occurred in 3 (10%) patients that presented at the acute stage.
Conclusions: The patients undergoing thoracoabdominal trauma, should be explained the probability,
although low, of rupture of the diaphragm. These patients should be followed
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