Karhof S, Simmermacher R K J, Gerbranda P, van Wessem K J P, Leenen L P H, Hietbrink F
Department of Surgery, University Medical Centre Utrecht, Utrecht, Netherlands.
Front Surg. 2024 Dec 9;11:1489260. doi: 10.3389/fsurg.2024.1489260. eCollection 2024.
A traumatic diaphragm defect is a rare injury. A missed diaphragm injury may cause serious morbidity and mortality. Detection rate during the first assessment of trauma patients is notoriously low. However, important improvements in imaging modalities were developed. The aim of this study was to analyze traumatic diaphragm injuries in relation to diagnostic tools, therapeutic interventions and outcome over the past two decades.
A retrospective analysis was performed of all trauma patients with traumatic diaphragm injuries between 2000 and 2018 at a level I trauma center. Data collected were baseline characteristics, diagnostics that were performed, treatment given and follow-up.
A total of 47 patients with traumatic diaphragm injuries were evaluated. The majority of injuries was seen following blunt trauma (72%). Mortality was 21%, mainly due to concomitant injuries. One patient died due to the consequences of an unrecognized diaphragm injury. In 29 cases (62%) the injury was diagnosed pre-operatively through imaging, with the remaining being diagnosed during laparotomy. In 11 patients (35%) the diaphragmatic injury was not seen on a pre-operative CT-scan. Postoperative complications occurred in 19 patients, mostly of pulmonary origin (i.e., pneumonia). No recurrences were reported.
This study confirms diaphragm injuries are infrequent injuries, with high mortality. Even more, despite major improvement in diagnostic modalities over the past 2 decades, the algorithm for detection of diaphragmatic injuries has not changed nor has its outcome. Although the incidence is low, since consequences are severe, it is important to have a high index of suspicion in abdominal trauma, even in a non-conclusive CT-scan.
创伤性膈肌缺损是一种罕见的损伤。漏诊的膈肌损伤可能导致严重的发病率和死亡率。创伤患者首次评估时的检出率极低。然而，影像学检查方法有了重要改进。本研究的目的是分析过去二十年中与诊断工具、治疗干预措施及预后相关的创伤性膈肌损伤情况。
对2000年至2018年期间在一级创伤中心就诊的所有创伤性膈肌损伤患者进行回顾性分析。收集的数据包括基线特征、所进行的诊断、给予的治疗及随访情况。
共评估了47例创伤性膈肌损伤患者。大多数损伤发生在钝性创伤后（72%）。死亡率为21%，主要是由于合并伤。1例患者因未被识别的膈肌损伤后果死亡。29例（62%）患者术前通过影像学检查确诊，其余患者在剖腹手术时确诊。11例（35%）患者术前CT扫描未发现膈肌损伤。19例患者出现术后并发症，大多源于肺部（如肺炎）。未报告复发情况。
本研究证实膈肌损伤是罕见损伤，死亡率高。更重要的是，尽管过去二十年诊断方法有了重大改进，但膈肌损伤的检测方法及其预后并未改变。虽然发病率低，但由于后果严重，对于腹部创伤患者，即使CT扫描结果不明确，也必须保持高度怀疑。
