This document discusses diaphragmatic injuries, their causes, signs and symptoms, diagnosis, and management. Diaphragmatic injuries occur most often from penetrating trauma (65%) or blunt trauma (35%) to the abdomen or chest. Associated injuries to other organs are common, occurring in 80-100% of diaphragmatic injury cases. Diagnosis can be made through chest x-rays, ultrasound, CT scans, or laparoscopy, with CT scans having high sensitivity and specificity. Management involves surgical exploration and repair of the diaphragm, often through laparotomy. Complications can include herniation of abdominal organs into the chest if left untreated.
7. MECHANISM OF INJURY
🞭 Penetrating injury
🞭 stabs, gunshot, shotgun and impalements
🞭 Small wound (1-3 cm.)
🞭 Blunt injury
🞭 More common in left side (3-4 times)
🞭Posterolateral aspect
🞭 Blunt force to abdomen or chest elevate
pressure > +150-200 cmH2O
🞭 Wound size 5-10 cm.
8. SIGN AND SYMPTOM
🞭 Early
🞭 Shortness of breath
🞭 Dyspnea
🞭 Decreased breath sound
🞭 Paradoxical movement of chest wall
🞭 Late
🞭 Abdominal pain
🞭 Clinical of gut obstruction
🞭 Audible bowel sound from chest area
9. DIAGNOSTIC
🞭 Suspected DI in patient with
🞭 Blunt injury
🞭Blunt thoracic or abdomen injury
🞭Multiple fracture lower rib
🞭 Penetrating injury
🞭Thoracoabdominal area (T4-T12)
🞭 Delayed presentation
🞭 Herniation of abdominal organ
10. WORK UP
🞭 Chest radiography
🞭 Ultrasound
🞭 Computer tomography
🞭 Magnetic resonance imagine
🞭 Laparoscopy
🞭 Explore-Laparotomy
11. CHEST RADIOGRAPHY
🞭 Visualization of the stomach or other
abdominal organs in the chest
🞭 Elevation of the diaphragm
🞭 Lack of clarity of the hemidiaphragm
🞭 Abnormal positioning of a nasogastric tube
🞭 Basilar atelectasis
🞭 Hemothorax from bleeding in the abdomen
14. ULTRASOUND
🞭 FAST
🞭 not standardized and a negative study
cannot be used to exclude the diagnosis
🞭 Finding
🞭 discontinuity of diaphragm
🞭 Hernia
🞭 Floating diaphragm
🞭 Nonvisualized diaphragm
15. DPL
🞭 To improve its sensitivity for diagnosing
diaphragmatic injuries in penetrating
thoracoabdominal trauma, many clinicians
have modified the red blood count (RBC)
criteria, accepting lower RBC counts
(>10,000/mm3) to decrease the rate of false
negative results.
16. CT
🞭 Discontinuity of the diaphragm
🞭 Herniation of the abdominal contents into the chest
🞭 Abnormal positioning of a nasogastric tube
🞭 Waist-like constriction of bowel
🞭 Viscera (liver, stomach) are in direct contact with the
posterior ribs
🞭 Contiguous injury from one side of the diaphragm to
the other (ie, left pulmonary laceration and splenic
laceration)
🞭 Sensitivity 82-87 % Specificity 72-99 % - in blunt
abdominal injury