Yıl: 2015 Cilt: 21 Sayı: 6 Sayfa Aralığı: 484 - 490 Metin Dili: İngilizce İndeks Tarihi: 29-07-2022

The diagnostic efficacy of computed tomography in detecting diaphragmatic injury secondary to thoracoabdominal penetrating traumas: a comparison with diagnostic laparoscopy

Öz:
BACKGROUND: This study was designed to investigate the diagnostic efficacy of computed tomography (CT) for the detection diaphragmatic injury in cases undergoing diagnostic and therapeutic laparoscopy in left thoracoabdominal penetrating injuries.METHODS: Demographic properties, stabbed body region, additional injuries, hemodynamic parameters, time to admission, diagnostic examinations, and type of treatment were retrospectively reviewed in one hundred and eight patients presenting with left thoracoabdominal injury after penetrating sharp object injury between April 2010 and December 2014. Preoperative CT scans of all patients were reviewed blind to the results of surgical evaluation. The relationship between diaphragmatic injury and hemothorax, pneumothorax, abdominal free fluid, and solid organ injuries were analyzed. All patients underwent physical examination, complete blood count monitoring, and hemodynamic assessment prior to surgery.RESULTS: The most common finding on physical examination was anterior left thoracoabdominal injury. The injury was detected surgically in 36% of twenty-five cases with lateral injury. Diaphragmatic injury was present in twenty-five (23.1%) of all cases, all of whom were treated with laparoscopic repair. An analysis of all CT findings in relation to surgical results revealed that CT had a sensitivity of 80%, a specificity of 95%, a PPV of 83%, and a NPV of 94% for the detection of diaphragmatic injuries. Mean duration of hospital stay was 5.4 days (range, 1-16 days) in the entire study population.CONCLUSION: CT is still associated with diagnostic challenges in penetrating diaphragmatic injuries. Nevertheless, CT showed a high specificity and a negative predictive value in our study. Detection of a diaphragmatic defect and fatty tissue herniation makes the definitive diagnosis of diaphragmatic injury in penetrating thoracoabdominal injuries. Prospective studies with a larger sample size are necessary to further clarify the role of CT in detection of diaphragmatic injuries in thoracoabdominal sharp penetrating object injuries
Anahtar Kelime:

Konular: Cerrahi
Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • Balaguera J, Garcia-Almata M, Segovia J, Aquiriano L, Delgado de Tórres S, Gamarra S, et al. Delayed asymptomatic left traumatic diaphragmatic hernia after abdominal stab wound. The Internet Journal of Surgery 2008;17:2.
  • Bodanapally UK, Shanmuganathan K, Mirvis SE, Sliker CW, Fleiter TR, Sarada K, et al. MDCT diagnosis of penetrating diaphragm injury. Eur Radiol 2009;19:1875-81.
  • Panda A, Kumar A, Gamanagatti S, Patil A, Kumar S, Gupta A. Trau- matic diaphragmatic injury: a review of CT signs and the difference be- tween blunt and penetrating injury. Diagn Interv Radiol 2014;20:121-8.
  • American College of Surgeons. Advanced trauma life support, Chicago, 1997.
  • Clarke DL, Allorto NL, Thomson SR. An audit of failed non-operative management of abdominal stab wounds. Injury 2010;41:488-91.
  • Kent AL, Jeans P, Ewards JR, Byrne PD. Ten year review of thoracic and abdominal penetrating trauma management. Aust N Z J Surg 1993;63:772-9.
  • Navsaria PH, Berli JU, Edu S, Nicol AJ. Non-operative management of abdominal stab wounds--an analysis of 186 patients. S Afr J Surg 2007;45:128-32.
  • Biffl WL, Kaups KL, Cothren CC, Brasel KJ, Dicker RA, Bullard MK, et al. Management of patients with anterior abdominal stab wounds: a Western Trauma Association multicenter trial. J Trauma 2009;66:1294- 301.
  • O'Malley E, Boyle E, O'Callaghan A, Coffey JC, Walsh SR. Role of lapa- roscopy in penetrating abdominal trauma: a systematic review. World J Surg 2013;37:113-22.
  • Lin HF, Wu JM, Tu CC, Chen HA, Shih HC. Value of diagnostic and therapeutic laparoscopy for abdominal stab wounds. World J Surg 2010;34:1653-62.
  • Sugrue M, Balogh Z, Lynch J, Bardsley J, Sisson G, Weigelt J. Guide- lines for the management of haemodynamically stable patients with stab wounds to the anterior abdomen. ANZ J Surg 2007;77:614-20.
  • Friese RS, Coln CE, Gentilello LM. Laparoscopy is sufficient to exclude occult diaphragm injury after penetrating abdominal trauma. J Trauma 2005;58:789-92.
  • Bagheri R, Tavassoli A, Sadrizadeh A, Mashhadi MR, Shahri F, Shojae- ian R. The role of thoracoscopy for the diagnosis of hidden diaphragmatic injuries in penetrating thoracoabdominal trauma. Interact Cardiovasc Thorac Surg 2009;9:195-8.
  • Hammer MM, Flagg E, Mellnick VM, Cummings KW, Bhalla S, Raptis CA. Computed tomography of blunt and penetrating diaphragmatic in- jury: sensitivity and inter-observer agreement of CT Signs. Emerg Radiol 2014;21:143-9.
  • Stein DM, York GB, Boswell S, Shanmuganathan K, Haan JM, Scalea TM. Accuracy of computed tomography (CT) scan in the detection of penetrating diaphragm injury. J Trauma 2007;63:538-43. OLGU SUNUMU
  • Torakoabdominal delici-kesici alet yaralanmalarında bilgisayarlı tomografinin diyafragma
  • yaralanmasını göstermedeki etkinliği, tanısal laparoskopi ile karşılaştırma
  • Dr. Mehmet İlhan,1 Dr. Mesut Bulakçı,2 Dr. Süleyman Bademler,1 Dr. Ali Fuat Kaan Gök,1
  • Dr. İbrahim Fethi Azamat,1 Dr. Cemalettin Ertekin1
  • İstanbul Üniversitesi İstanbul Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, Travma ve Acil Cerrahi Servisi, İstanbul, Türkiye
  • İstanbul Üniversitesi İstanbul Tıp Fakültesi, Radyoloji Anabilim Dalı, İstanbul
  • AMAÇ: Sol torakoabdominal delici kesici yaralanması olan, tanısal veya terapotik laparoskopi yapılan hastalarda bilgisayarlı tomografinin (BT) diyaf
  • ram yaralanmasını saptamadaki etkinliğinin değerlendirilmesi.
  • GEREÇ VE YÖNTEM: Nisan 2010 ile aralık 2014 tarihleri arasında delici-kesici alet yaralanması ile başvuran sol torakoabdominal yaralanması bu
  • lunan 108 olgu demografik verileri, bıçaklanma bölgesi, ek travma bulgularının varlığı, hemodinamik parametreleri, başvuru süresi, tanı yöntemleri
  • ve tedavi şekli açısından geriye dönük olarak değerlendirildi. Tüm hastaların ameliyat öncesi bilgisayarlı tomografi görüntüleri geriye dönük olarak
  • cerrahi değerlendirme sonuçları bilinmeden değerlendirilmiştir. Hemotoraks, pnömotoraks, batında serbest sıvı ve solid organ yaralanmalarının
  • diyaframa yaralanması ile ilişkisi araştırıldı. Cerrahi girişim öncesinde tüm olgular fizik muayene, hemogram takibi ve hemodinamik değerlendirme ile takip edildi.
  • BULGULAR: Fizik muayene bulgusu olarak en sık anterior sol torakoabdominal yaralanma saptandı. Lateral yaralanması olan 25 olgunun %36'sında
  • cerrahi olarak yaralanma saptandı. Tüm olguların 25'inde (%23.1) diyafragma yaralanması saptandı ve olgulara laparaskopik tamir yapıldı. Tüm BT
  • bulguları cerrahi sonuçları ile birlikte değerlendirildiğinde diyafragma yaralanmasını göstermede sensitivite %80, spesifite %95, PPV %83, NPV %94
  • olarak hesaplanmıştır. Ortalama hastanede kalış süresi tüm olgularda 5.4 gün (1-16) olarak gözlendi.
  • TARTIŞMA: Bilgisayarlı tomografi ile penetran diyafragma yaralanmalarını değerlendirmede halen güçlükler mevcuttur. Buna rağmen bizim çalışma
  • mızda BT yüksek spesifite ve negatif prediktif değere sahiptir. Diyafragma defekti ve yağlı doku herniasyonunun tespit edilmesi torakoabdominal ya
  • ralanmalarda kesin tanıyı koydurmaktadır. Daha fazla sayıda hasta grubu ile ileriye yönelik çalışma yapılması, delici kesici alete bağlı torakoabdominal
  • yaralanması olan hastalarda diyafram yaralanmasının saptanmasında BT'nin rolünü belirlemede faydalı olacaktır.
  • Anahtar sözcükler: ÇKBT; delici kesici alet yaralanması; diyafragma yaralanması; laparoskopi; torakoabdominal.
  • Ulus Travma Acil Cerrahi Derg 2015;21(6):484-490 doi: 10.5505/tjtes.2015.94389
APA ilhan M, BULAKCI M, bademler s, Azamat İ, ERTEKİN C (2015). The diagnostic efficacy of computed tomography in detecting diaphragmatic injury secondary to thoracoabdominal penetrating traumas: a comparison with diagnostic laparoscopy. , 484 - 490.
Chicago ilhan Mehmet,BULAKCI MESUT,bademler süleyman,Azamat İbrahim Fethi,ERTEKİN Cemalettin The diagnostic efficacy of computed tomography in detecting diaphragmatic injury secondary to thoracoabdominal penetrating traumas: a comparison with diagnostic laparoscopy. (2015): 484 - 490.
MLA ilhan Mehmet,BULAKCI MESUT,bademler süleyman,Azamat İbrahim Fethi,ERTEKİN Cemalettin The diagnostic efficacy of computed tomography in detecting diaphragmatic injury secondary to thoracoabdominal penetrating traumas: a comparison with diagnostic laparoscopy. , 2015, ss.484 - 490.
AMA ilhan M,BULAKCI M,bademler s,Azamat İ,ERTEKİN C The diagnostic efficacy of computed tomography in detecting diaphragmatic injury secondary to thoracoabdominal penetrating traumas: a comparison with diagnostic laparoscopy. . 2015; 484 - 490.
Vancouver ilhan M,BULAKCI M,bademler s,Azamat İ,ERTEKİN C The diagnostic efficacy of computed tomography in detecting diaphragmatic injury secondary to thoracoabdominal penetrating traumas: a comparison with diagnostic laparoscopy. . 2015; 484 - 490.
IEEE ilhan M,BULAKCI M,bademler s,Azamat İ,ERTEKİN C "The diagnostic efficacy of computed tomography in detecting diaphragmatic injury secondary to thoracoabdominal penetrating traumas: a comparison with diagnostic laparoscopy." , ss.484 - 490, 2015.
ISNAD ilhan, Mehmet vd. "The diagnostic efficacy of computed tomography in detecting diaphragmatic injury secondary to thoracoabdominal penetrating traumas: a comparison with diagnostic laparoscopy". (2015), 484-490.
APA ilhan M, BULAKCI M, bademler s, Azamat İ, ERTEKİN C (2015). The diagnostic efficacy of computed tomography in detecting diaphragmatic injury secondary to thoracoabdominal penetrating traumas: a comparison with diagnostic laparoscopy. Ulusal Travma ve Acil Cerrahi Dergisi, 21(6), 484 - 490.
Chicago ilhan Mehmet,BULAKCI MESUT,bademler süleyman,Azamat İbrahim Fethi,ERTEKİN Cemalettin The diagnostic efficacy of computed tomography in detecting diaphragmatic injury secondary to thoracoabdominal penetrating traumas: a comparison with diagnostic laparoscopy. Ulusal Travma ve Acil Cerrahi Dergisi 21, no.6 (2015): 484 - 490.
MLA ilhan Mehmet,BULAKCI MESUT,bademler süleyman,Azamat İbrahim Fethi,ERTEKİN Cemalettin The diagnostic efficacy of computed tomography in detecting diaphragmatic injury secondary to thoracoabdominal penetrating traumas: a comparison with diagnostic laparoscopy. Ulusal Travma ve Acil Cerrahi Dergisi, vol.21, no.6, 2015, ss.484 - 490.
AMA ilhan M,BULAKCI M,bademler s,Azamat İ,ERTEKİN C The diagnostic efficacy of computed tomography in detecting diaphragmatic injury secondary to thoracoabdominal penetrating traumas: a comparison with diagnostic laparoscopy. Ulusal Travma ve Acil Cerrahi Dergisi. 2015; 21(6): 484 - 490.
Vancouver ilhan M,BULAKCI M,bademler s,Azamat İ,ERTEKİN C The diagnostic efficacy of computed tomography in detecting diaphragmatic injury secondary to thoracoabdominal penetrating traumas: a comparison with diagnostic laparoscopy. Ulusal Travma ve Acil Cerrahi Dergisi. 2015; 21(6): 484 - 490.
IEEE ilhan M,BULAKCI M,bademler s,Azamat İ,ERTEKİN C "The diagnostic efficacy of computed tomography in detecting diaphragmatic injury secondary to thoracoabdominal penetrating traumas: a comparison with diagnostic laparoscopy." Ulusal Travma ve Acil Cerrahi Dergisi, 21, ss.484 - 490, 2015.
ISNAD ilhan, Mehmet vd. "The diagnostic efficacy of computed tomography in detecting diaphragmatic injury secondary to thoracoabdominal penetrating traumas: a comparison with diagnostic laparoscopy". Ulusal Travma ve Acil Cerrahi Dergisi 21/6 (2015), 484-490.