Diaphragmatic rupture due to blunt trauma : useful respiratory and circulatory abnormalities and diagnostic imaging for early diagnosis and treatment

概要

論文の詳細を見る
Diaphragmatic rupture is a relatively infrequent injury and rupture due to blunt trauma is often missed because of other associated injuries, leading to delay in the correct diagnosis and management. We experienced 10 cases of diaphragmatic rupture due to blunt trauma from 1982 to 2001. All of these patients were transferred from other hospitals. Among them, seven patients were male and three were female, the age range was 21 to 62 years (average : 49.2 years), and 7 patients had left hemidiaphragmatic rupture and 3 had right-sided rupture. The rupture was 8 to 15 cm in diameter on the left side and 2 to 20 cm on the right side. As organs prolapsing through the rupture, stomach, small bowel, transverse colon, liver, and spleen were observed on the left side, while the liver was always involved on the right. Physical findings at the time of hospitalization included respiratory shortness and cough as subjective symptoms, while decreased respiratory noises were noted in many cases as objective symptoms. As for vital signs, a decrease of blood pressure and tachypnea were more common with left-sided rupture than right-sided rupture. With regard to laboratory findings, analysis of arterial blood gases often revealed that Pa0_2 was markedly decreased, while no increase of PaCO_2 was observed. As imaging findings related to diaphragmatic rupture, an elevated hemidiaphragm, malposition of abdominal organs, hemopneumothorax, and rib fracture were seen on thoraco-abdominal plain X-ray, while loss of the diaphragmatic contour and malposition of abdominal organs were noted on thoraco-abdominal CT scans. While most patients underwent surgery within three hours of hospitalization, there was one case where operation was delayed until the third day. It is important to observe the changes in physical findings, vital signs, laboratory tests, and imaging findings over time to achieve early diagnosis of diaphragmatic rupture due to blunt trauma. In patients with diaphragmatic rupture, cardiogenic shock and a decrease of PaO_2 are seen in addition to severe chest symptoms such as airway obstruction. When diaphragmatic rupture is suspected, thoracic plain X-ray should be taken at expiration and inspiration. When evidence is lacking to make a definite diagnosis and diaphragmatic rupture is suspected, it is necessary to perform thoracography at an early stage and confirm the leakage of contrast medium into the abdominal cavity. We performed surgical treatment for diaphragmatic rupture which depended on the severity of associated injuries to organs in the thoracic and abdominal cavities. The prognosis was good in all of our patients.
近畿大学の論文

Diaphragmatic rupture due to blunt trauma : useful respiratory and circulatory abnormalities and diagnostic imaging for early diagnosis and treatment

スポンサーリンク

概要

著者

関連論文

スポンサーリンク