Traumi del diaframma.

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Antonino Buffone, Guido Basile, Silvana Leanza, Francesco Scirè, Antoinette Marie Bonaccorso, Ercole Cirino

Ann. Ital. Chir., 2006; 77: 385-389

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OBJECTIVE: Diaphraghmatic injuries are rare (5-7%), usually secondary to blunt, or more rarely penetrating, thoracic or
abdominal trauma. The most frequent site of trauma is the left postero-lateral region. We’ll try to review this pathology
in all its aspects.
MATERIALS AND METHOD: We report our personal experience from January 2002 to December 2004 on 280 thoracoabdominal
trauma, 262 (93.5%) blunt and 18 (6.5%) penetrating, of which 5 (3.7%) interested the diaphragm. 4
following a blunt trauma and 1 an open trauma (gunshot) Each trauma was evaluated for possible associated injuries
and for the type of symptoms at the admission and during the hospitalization. Preoperative diagnosis has been obtained
only in 3 patients, haemodynamically stable. In the other 2 cases an emergency laparotomy was carried out because of
their critic conditions and the diaphragmatic injuries were recognized during the procedure. Two patients died.
CONCLUSIONS: We remark as during the acute phase the diaphragmatic rupture may be missed because of shock, respiratory
insufficiency or coma of the patient; however, it’s mandatory that the right diagnosis is reached as soon as possible
in order that mortality is mostly influenced by the time elapsing between trauma and diagnosis.

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