Mehmet İlhan1, Mesut Bulakçı2, Süleyman Bademler3, Ali Fuat Kaan Gök3, İbrahim Fethi Azamat3, Cemalettin Ertekin3. 1. Department of General Surgery, Trauma and Emergency Surgery Service, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey. op.dr.mehmetilhan@gmail.com. 2. Department of Radiology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey. 3. Department of General Surgery, Trauma and Emergency Surgery Service, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey.
Abstract
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.
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.