alexa Laparoscopic Repair of a Computed Tomography-Detected Diaphragmatic Stab Wound | Open Access Journals
ISSN: 2329-9126
Journal of General Practice
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Laparoscopic Repair of a Computed Tomography-Detected Diaphragmatic Stab Wound

Yaron D Barac1*Krauzs Michel2Aravot Dan1,2
1Department of Cardiothoracic Surgery, Carmel Medical Center, Haifa, Israel
2Technion, Israel Institute of Technology, The Ruth and Bruce Rappaport Faculty of Medicine, Israel
Corresponding Author : Yaron D Barac
Department of Cardiothoracic Surgery
Carmel Medical Center, 7 Michal St., Haifa, Israel
Tel: +972 48295964, +972 507259933
Fax: +972 48295969
E-mail: [email protected]
Received July 05, 2013; Accepted July 17, 2013; Published July 25, 2013
Citation: Barac YD, Michel K, Dan A (2013) Laparoscopic Repair of a Computed Tomography-Detected Diaphragmatic Stab Wound. J Gen Pract 1:115. doi:10.4172/2329-9126.1000115
Copyright: © 2013 Barac YD, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Abstract

Traumatic diaphragmatic injuries are associated with delayed diagnosis and consequential morbidity and mortality, due to concomitant injuries of proximal organs overshadowing visibility of the diaphragm as well as the difficulty of the various available modalities to diagnose diaphragmatic injury. The presented case involved a penetrating computed tomography-detected diaphragmatic injury, repaired via abdominal laparoscopy/open technique.

Keywords
Diaphragm laceration; CT; Laparoscopic repair; Stab wound
Introduction
Diaphragmatic penetrating trauma is rare, and often associated with delayed recognition due to late manifestation [1] or concomitant injury to the skeleton, lungs, central nervous system and/or abdominal viscera which obscure the diaphragmatic injuries [2]. Delayed diagnosis is correlated with high mortality rates [2,3], a direct consequence of herniation, strangulation and other complications. Such wounds typically involve a left side injury to the upper abdomen and lower chest, seemingly due to the protective effect of the liver and the typical right-handedness of the assailant [4,5]. An abdominal laparoscopic approach has proven effective in acute diaphragmatic wound closure in stable patients.
Case Report
A 23-year-old man, self-admitted to the hospital emergency room, reported a stab injury to the left upper abdominal quadrant, the patient was hemodynamic stable and was treated and diagnosed on an ATLS basis, Fluids were administered and the patient remained normotensive. FAST did not reveal any free fluid in his abdomen, and though his clinical status nor did the local exploration of the wound mandated a CT, a high index of suspicion due to the stabbing location, convinced us that CT will be appropriate. On physical examination, a 3 cm wound in his left upper abdominal quadrant was noted. The patient breathing was normal and no decrease was noted in his saturation. Moreover, no abdominal distention or tenderness was detected. FSAT evaluation of the abdominal area showed no evidence of injury. A Computed Tomography (CT) scan detected a single injury, a diaphragmatic laceration (Figure 1). An abdominal laparoscopic approach was taken for optimal accessibility and correction. However, the operation was converted to an open surgery due to air transfer from the abdominal cavity to the thorax which made the patient ventilation difficult. The diaphragm was corrected by a primary laceration repair approach. The patient was discharged on the 3rd postoperative day.
Discussion
While occult diaphragmatic injuries are difficult to detect, the resulting pleuroperitoneal pressure gradients can be fatal. Thus, a high index of suspicion is necessary upon presentation of thoracic and abdominal injuries, or history of high velocity injuries.
Conclusion
Diaphragmatic lacerations often go undetected and multiple detection modalities must be exploited, particularly when a suspicion of such injuries is high. Laparoscopic repair of diaphragmatic laceration is suitable and safe however conversion to open must take place once the patient ventilation is endangered.
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