The role of thoracoscopy for the diagnosis of hidden diaphragmatic injuries in penetrating thoracoabdominal trauma.

Patients with a thoracoabdominal stab wound may have hidden diaphragmatic injuries that could finally lead to chronic diaphragmatic hernia. In this study, we analyzed 30 patients with penetrating thoracoabdominal injuries that were stable hemodynamically and did not need emergency exploration. They underwent thoracoscopy in order to find a probable diaphragmatic injury from March 2005 to October 2007. The mean age was 26.2 years and the M/F ratio was 5:1. We observed five occult diaphragmatic injuries (16.7%) in thoracoscopic evaluations. Three cases (9.9%) were repaired through a thoracoscopic approach while laparatomy was inevitable in two (6.6%) patients. Pulmonary parenchymal lacerations were observed in two patients (6.6%) which were repaired through thoracoscopy and intra-abdominal injury was observed in one patient (3.3%) which was repaired via laparatomy. We performed thoracoabdominal CT-scan 6 months later and chronic diagrammatic hernias were not reported. Diagnostic accuracy of thoracoscopy was 100%. Owing to the high diagnostic accuracy rate, minimal invasiveness and therapeutic potency of thoracoscopy we recommend it to be performed in all clinically stable patients with penetrating thoracoabdominal penetrating injury especially in the 8th intercostal space.