Laparoscopic Management of Left Thoracoabdominal Stab Wounds: A Prospective Study (original) (raw)
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South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie, 2017
The purpose of this study was to determine whether patients with left-sided thoracoabdominal (TA) stab wounds can be safely treated with clinical and chest X-ray follow up. A prospective, randomized control study was conducted at Groote Schuur Hospital from September 2009 through to November 2014. Patients with asymptomatic left TA stab wounds included in the trial were randomized into two groups. Group A underwent diagnostic laparoscopy and Group B underwent clinical and radiological follow-up. Twenty-seven patients were randomized to Group A (N=27) and thirty-one to Group B (N=31). All patients were young males with a median age of 26 years (range 18 to 48). The incidence of occult diaphragm injury in Group A was 29%. All diaphragm injuries found at laparoscopy were repaired. The mean hospital stay for the patients in Group A was 5 days (SD 1.3), compared to a mean hospital stay of 2.9 days (SD, 1.5), in Group B (p < 0.001). All patients in Group B had normal chest X-rays at th...
Laparoscopic repair of penetrating injury of the diaphragm: an experience from a district hospital
The Libyan Journal of Medicine, 2008
In this study we review our experience in using laparoscopy as a diagnostic and therapeutic tool in dealing with penetrating diaphragmatic injuries due to stab wounds and look at the feasibility of using this procedure in other similar institutions. Thirty patients, all of whom were males 20-30 years of age, presented to the surgical emergency unit of our hospital with upper abdominal and lower chest wall stab wounds between 01-05-1998 and 30-11-2006. Diagnosis of the diaphragm injury was either obvious with omentum herniating through the chest wall, or occult with confirmation of the injury at laparoscopy. All patients underwent diagnostic laparoscopy, which resulted in identification and efficient treatment of eight patients with diaphragmatic injury, and thereby laparotomy was avoided. The procedure converted to open surgery in one patient because of a small left-sided colonic tear. Laparoscopy is an efficient tool for the diagnosis and management of diaphragmatic injuries. It should be used routinely instead of exploratory laparotomy in haemodynamically stable patients with penetrating lower chest injuries.
Surgical Endoscopy, 2014
Background Diaphragmatic injuries from penetrating thoracoabdominal trauma are notoriously difficult to detect with clinical and radiological evaluation. The aim of this study was to establish the incidence of diaphragmatic injury from penetrating thoracoabdominal trauma, clinical and radiological features predictive of a diaphragmatic injury and the feasibility of laparoscopic repair. Methods This is a prospective consecutive case series conducted in a metropolitan hospital complex. Fifty five patients were enrolled into the study and underwent a standardized laparoscopic procedure. Only stable patients were selected and right-sided penetrating thoracoabdominal injuries were excluded. The patients' clinical details, radiological findings, operative procedure, treatment of the diaphragmatic injury and complications were collected and analysed. Results There were a total of 55 patients, of whom, 22 (40 %) had diaphragmatic injuries. The mean age was 26.3 ± 7.8 years (range 15-44) with a male:female ratio of 10:1. The causes of injury were stab in 54 (98.2 %) patients and firearm in one (1.8 %). Twenty six (47.3 %) patients had positive radiological findings, of which 10 (38.5 %) had a diaphragmatic injury. There were 6 (27.3 %) associated intraabdominal injuries. Twenty one (95.5 %) of 22 patients with diaphragmatic injuries were successfully repaired laparoscopically. Mean duration of procedure with diaphragmatic repair was 74.9 ± 22.5 min compared to 38.3 ± 16.9 min without diaphragmatic repair. Six patients (10.9 %) had minor intra-operative complications. There were no deaths. Hospital stay was 2.9 ± 3.4 days.
Thoracoscopy in the diagnosis and treatment of thoracoabdominal stab injuries
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES, 2007
Occult diaphragmatic injuries are associated with significant mortality, if the diagnosis is delayed. We report our experience in diagnostic and therapeutic thoracoscopy in a selected group of patients with stab wounds of thoracoabdominal region. The patients who underwent thoracoscopic management of thoracoabdominal stab injuries between June 2001-December 2005 were included into the study. The data were retrospectively analyzed. Ninety-three patients with abdominal and thoracoabdominal stab wounds underwent videoendoscopic management. Among them, eleven selected patients with thoracoabdominal stab injuries were managed by thoracoscopy. The procedures were performed under general (n=10) or local anesthesia (n=1). Diaphragmatic injuries were repaired by intracorporeal sutures in three cases and bleeding was controlled in another two cases by electrocautery coagulation. The procedures were simply diagnostic in six patients. The mean operating time and hospital stay were 35 minutes an...
Penetrating Diaphragmatic Injury: A Lesson Learnt After Laparotomy
The Internet Journal of Surgery, 2013
Traumatic diaphragmatic injuries still are difficult to diagnose; it needs a high index of suspicion in patients having severe thoracoabdominal blunt or penetrating trauma. To diagnose them accurately, poses a challenge to trauma surgeons, especially in cases of small injuries, which later may be diagnosed as diaphragmatic hernias, and their complications. An emergency laparotomy followed by repair of the defect is gold standard in the management of these patients. Herein, we report a case of penetrating diaphragmatic injury in a young female having multiple stab wounds on the left side of the chest and the abdomen with a chest x-ray showing air under the right dome of the diaphragm.
Occult Diaphragmatic Injuries Caused by Stab Wounds
The Journal of Trauma: Injury, Infection, and Critical Care, 2003
Background: Missed diaphragmatic perforation caused by penetrating trauma can lead to subsequent strangulation of a hollow viscus, which has prompted the use of invasive diagnostic procedures to exclude occult diaphragmatic injuries in asymptomatic, high-risk patients. The objective of this study was to determine the incidence of occult diaphragmatic injuries caused by stab wounds of the lower chest and upper abdomen, and to examine the natural history and consequences of missed diaphragmatic injuries. Methods: On the basis of patient data from two previous randomized studies from our institution, a retrospective analysis was performed on 97 patients treated for anterior stab wounds located between the nipple line, the umbilical level, and the posterior axillary lines not having indications for immediate surgical exploration. The patients were divided into two groups on the basis of their initial randomized management (open or laparoscopic exploration vs. expectant observation). Results: In the exploration group (n ؍ 47), four diaphragmatic injuries (9%) were detected (three left-sided and one right-sided). Excluding patients with associated injuries requiring surgical repair, the incidence of occult diaphragmatic injuries was 3 of 43 (7%). In the observation group (n ؍ 50), there were two patients (4%) with delayed presentation of missed left-sided diaphragmatic injury 2 and 23 months later, respectively. Both injuries resulted from stab wounds of the left flank and presented with herniation of the stomach or small bowel and colon. The overall incidence of occult diaphragmatic injuries in left-sided thoracoabdominal stab wounds was 4 of 24 (17%), and was much lower after stab wounds of left epigastrium (0%), right lower chest (0%), and right epigastrium (4%). Conclusion: In asymptomatic patients with anterior or flank stab wounds of the lower chest or upper abdominal area, the risk of an occult diaphragmatic injury is approximately 7% which, if undetected, is associated with a high risk of subsequent hollow viscus herniation. Exclusion of an occult diaphragmatic injury with invasive diagnostic methods, such as laparoscopy or thoracoscopy, should be considered at least in left-sided stab wounds of the lower chest.
2012
Diaphragmatic injury is probable in penetrating trauma to the thorax below nipple line and patients should be evaluated to rule it out Chest XRay , Ultrasonography , CT scan ,Pneumopertineum and abdominal paracentesis are usually limited in diagnosing diaphragmatic injury and many cases may be missed with these diagnostic modalities. Thoracoscopy is known as an accurate method for diagnosis of diaphragmatic injury. The purpose of this study in to introduce thoracoscopy as a procedure for diagnosis of diaphragmatic injury in stab wounds to the lower thoracic area and to evaluate the efficacy of physical examination with finger through the wound in comparison with thoracoscopy in the diagnosis of these injuries. Hemodynamically stable patients with stab wound to the lower thoracic area studied. First patients examined with finger through the wound and then the accuracy of digital exploration in the diagnosis of diaphragmatic injury evaluated with thoracoscopy.42 patients (15 to 30 years) studied. 30 patients (71.4%) had stab wound to left side. 28 patients (66.7%) had stab wound to anterior chest. Results of physical examination were positive in 7 (16.7%) negative in 32 (79.2%) and inconclusive in 3 (7.1%) patients. All patients with diaphragmatic injury confirmed with thoracoscopy were diagnosed with digital exploration too; and all negative cases in physical examination had intact diaphragm in thoracoscopy. Putting inconclusive cases aside sensitivity specificity positive and negative predictive value of digital exploration in the diagnosis of diaphragmatic injuries due to stab wound to lower thoracic area were 100%.Digital exploration through the wound is an accurate simple and inexpensive procedure for the diagnosis of diaphragmatic injury in stab wounds to the lower thoracic area that without need to general anesthesia or additional incisions allows early diagnosis of diaphragmatic lesions in cases that the exam is inconclusive the procedure can be performed using general anesthesia or thoracoscopy may be considered as an alternative diagnostic method. [Alireza Khazaei,Mostafa Dahmardehei, Behzad Narouie and Arash Beiraghi Toosi. Determination of efficacy of physical examination in the diagnosis diaphragmatic injuries due to stab wound to lower thoracic area confirmed with thoracoscopy.
Injury, 2008
Background: Occult diaphragmatic injury following penetrating thoracoabdominal trauma can be difficult to diagnose. Radiographic findings are often non-specific or absent. Undetected injuries may remain clinically silent, only to present later with life-threatening complications associated with diaphragmatic herniation. Diagnostic laparoscopy allows for the evaluation of trauma patients lacking clinical indications for a formal laparotomy. The purpose of this study was to evaluate the incidence of occult diaphragmatic injury and investigate the role of laparoscopy in patients with penetrating thoracoabdominal trauma who lack indications for exploratory laparotomy except the potential for a diaphragmatic injury. Methods: Haemodynamically stable patients with penetrating thoracoabdominal trauma without indications for laparotomy (haemodynamic instability, evisceration, or peritonitis on exam) and evaluated with diagnostic laparoscopy to determine the presence of a diaphragmatic injury were retrospectively reviewed. Thoracoabdominal wounds were defined as wounds bounded by the nipple line over the anterior and posterior chest superiorly and the costal margin inferiorly. Results: One hundred and eight patients were evaluated for penetrating thoracoabdominal injuries (80 stabs and 28 gunshots) over the study period. 22 (20%) diaphragmatic injuries were identified. These were associated with injuries to the spleen (5), stomach (3) and liver (2). There was a greater incidence of haemopneumothorax (HPTX) in patients with diaphragmatic injury (32%) compared to those without injury (20%). 29%
Successful Laparoscopic Repair of Posttraumatic Diaphragmatic Injury
Cureus, 2020
Diaphragmatic injuries can be a direct result of penetrating thoracoabdominal trauma such as gunshot or stab wounds. Diaphragmatic rupture can lead to herniation of intra-abdominal organs into the thoracic cavity. Diagnosis can be difficult as the results of a physical exam can be unremarkable. A CT scan of the chest is diagnostic for diaphragmatic injuries. In most emergency cases, diaphragmatic injuries are managed with laparotomy where CT was diagnostic. We report a rare case of a 25-year-old man with right diaphragmatic injury sustained after a stab wound to the right liver managed successfully with laparoscopy.