Relevance of early CT scan diagnosis of blunt diaphragmatic injury: A retrospective analysis from the Northern French Alps Emergency Network.

Details

Serval ID
serval:BIB_FC2E65A71FE8
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Relevance of early CT scan diagnosis of blunt diaphragmatic injury: A retrospective analysis from the Northern French Alps Emergency Network.
Journal
Journal of visceral surgery
Author(s)
Mancini A., Duramé A., Barbois S., Abba J., Ageron F.X., Arvieux C.
ISSN
1878-7886 (Electronic)
ISSN-L
1878-7886
Publication state
Published
Issued date
02/2019
Peer-reviewed
Oui
Volume
156
Number
1
Pages
3-9
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Diaphragmatic rupture following blunt trauma occurs rarely. Classically described after high-velocity accidents, ruptures are often associated with multiple organ injuries. The diagnosis is sometimes difficult. The goal of this study was to analyze and to discuss the modalities of early radiologic diagnosis and management of these injuries.
This multicenter retrospective study included patients seen between 2009 and 2017 within the Northern Alpine Emergency Network [REseau Nord Alpin des Urgences (RENAU)]. Clinical, radiologic and surgical data from all patients sustaining blunt diaphragmatic rupture were studied.
Thirty-one patients (18 men and 13 women), median age 44, were included. The principle mechanism of injury was road or traffic accidents for 22 patients. Diaphragmatic rupture occurred on the left side in 23 patients. Diagnosis was delayed in two patients, at 11 days and three months after the initial accident. Chest X-rays were diagnostic in 18 of 29 patients. CT scan was the reference investigation since it was performed in all patients and confirmed the diagnosis in 26 instances. Repair was surgical via a midline laparotomy in 27 patients, via laparoscopy in three, and via thoracoscopy in one. Three patients died.
At urgent surgical exploration in the unstable blunt trauma patient, the surgeon should keep in mind the relatively poor diagnostic performance of chest X-rays. Accurate diagnosis relies on routine inspection of the diaphragmatic cupolas. In the stable trauma victim, contrast-enhanced abdomino-thoracic CT with reconstruction can lead to early diagnosis, which allows for repair under optimal conditions, whether by laparotomy, laparoscopy or thoracoscopy, according to local conditions and expertise.
Keywords
Abdominal trauma, Diaphragmatic trauma, Thoracic trauma, Torso trauma
Pubmed
Web of science
Create date
11/02/2019 15:18
Last modification date
20/08/2019 17:27
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