PENETRATING LEFT THORACOABDOMINAL TRAUMA - THE INCIDENCE AND CLINICALPRESENTATION AT DIAPHRAGM INJURIES

Objective: The objective of this study was to (1) determine the incide nce of diaphragmatic injuries in penetrating left thoracoabdominal tra uma and (2) evaluate the role of laparoscopy in detecting clinically o ccult diaphragmatic injuries. Patients and Methods: One hundred ninete en consecutive patients with penetrating injuries to the left thoracoa bdominal region presenting to Los Angeles County-University of Souther n California Medical Center were prospectively evaluated during an 8-m onth period, Either celiotomy (with hemodynamic instability or periton itis) or laparoscopy was performed, Results of the clinical examinatio n and roentgenographic findings were recorded preoperatively. Results: One hundred seven patients were fully evaluated, Fifty patients requi red emergent celiotomy, Fifty-seven patients underwent laparoscopy. Th e overall incidence of diaphragmatic injuries was 42% (59% for gunshot wounds, 32% for stab wounds), Among the 45 patients with diaphragmati c injuries, 31% had no abdominal tenderness, 40% had a normal chest ro entgenogram, and 49% had an associated hemopneumothorax, Fifteen of th e patients undergoing laparoscopy (26%) had occult diaphragm injuries. Conclusion: (1) The incidence of diaphragmatic injuries in associatio n with penetrating left thoracoabdominal trauma is high. (2) The clini cal and roentgenographic findings are unreliable at detecting occult d iaphragmatic injuries, (3) Laparoscopy is a vital tool for detecting o ccult diaphragmatic injuries among patients who have no other indicati ons for formal celiotomy.