The role of thoracoscopy for the diagnosis of hidden diaphragmatic injuries in penetrating thoracoabdominal trauma
Reza Bagheri 1*,
Alireza Tavasoli 1,
Ali Sadrizadeh 1,
Mohammadtaghi Rajabi Mashhadi 1,
Faramarz Shahri 1,
Reza Shojaeian 1
1 Mashad University of Medical Sciences, Iran
* To whom correspondence should be addressed. E-mail: reza_bagheri_gts{at}hotmail.com.
 |
Abstract |
|---|
Patients with a thoracoabdominal stab wound may have hidden diaphragmatic injuries that could finally lead to chronic diaphragmatic hernia. In this study we analyzed thirty patients with penetrating thoracoabdominal injuries that were stable hemomodynamically and did not need emergent exploration. They underwent thoracoscopy in order to find a probable diaphragmatic injury from March 2005 to October 2007. The mean age was 26.2 years and the M/F ratio was 5:1. We observed 5 occult diaphragmatic injuries (16.7%) in thoracoscopic evaluations. 3 cases (9.9%) were repaired through thoracoscopic approach while laparatomy was inevitable in 2 (6.6%) patients. Pulmonary parenchymal lacerations were seen in 2 patients (6.6%) which were repaired through thoracoscopy and intra-abdominal injury was seen in 1 patient (3.3%) which was repaired via loparatomy. We performed thoracoabdominal CT-scan 6 months later and chronic diagrammatic hernias were not reported. Diagnostic accuracy of thoracoscopy was 100%. Owing to the high diagnostic accuracy rate, minimal invasiveness and therapeutic potency of thoracoscopy we recommend it to be performed in all clinically stable patients with penetrating thoracoabdominal penetrating injury especially in the 8th intercostal space. Keywords: Thoracoabdominal stab wound; Diaphragmatic injury; Thoracoscopy
