PURPOSE: Pnetrating thoracoabdominal stab wound may cause diaphragmatic and abdominal organs laceration and 15–20% of these patients who are stable and managed by conservative treatment may have hidden diaphragmatic injuries that would lead to chronic diaphragmatic hernia finally, so a safe and exact diagnostic method for evaluation of occult diaphragmatic injuries is very valuable. In this study we have assessed accurate diagnostic value of thoracoscopy in diagnosing occult diaphragmatic injuries in penetration thoracoabdominal stab wound.
METHODS: Thirty patients with Pnetrating thoracoabdominal injuries who were stable hemomodynamically and didn’t need emergent exploration were enrolled in this study. They underwent thoracoscopy to evaluate probable diaphragmatic injury, From March 2005 to October 2007. Diaphragmatic injuries were repaired via thoracoscopy or laparatomy and all patients were evaluated for chronic diaphragmatic hernia by CT-scan, 6 month later.
RESULTS: Mean age was 26.2 years and M/F was 5:1. We observed 5 hidden diaphragmatic injuries(16.7%) in thoracoscopic evaluations that 3 cases (9.9%) were repaired through thoracoscopic approach and laparatomy was inevitable in 2 (6.6%) patients. Lung paranchymal laceration was seen in 2 patients (6.6%) that repair performed with thoracoscopy and intra abdominal injury was seen in 1 patient (3.3%), that repair performed with loparatomy. Any complication wasn’t reported after thoracoscopy and there wasn’t any evidence of chronic diaphragmatic hernia in chest and abdominal CT-scan that was performed 6 month later so the diagnostic accuracy of thoracoscopy in occult diaphragmatic injuries in our study was 100%.
CONCLUSION: Because high diagnostic accuracy rate, minimal invasively and diagnostic and treatment ability of thoracoscopy we recommended that performed thoracoscopy in all clinically stable patients with penetrating thoracoabdominal stab wound.
CLINICAL IMPLICATIONS: The role of thoracoscopy for the diagnosis of hidden diaphragmatic injuries in penetrating Thoracoabdominal Trauma(stab wound).
DISCLOSURE: Reza Bagheri, No Financial Disclosure Information; No Product/Research Disclosure Information