Medicina de Emergência: Acesso Aberto
Acesso livre

Abstrato

Blunt Diaphragmatic Rupture a Case Report and Literature Review

Anas Al-Kahwa

Background: Diaphragmatic injury is a diagnostic and therapeutic challenge.
Materials and methods: We present a collective review of the clinical literature of 1167 patients treated for blunt diaphragmatic rupture (BDR) at various centres from 1957 to 2014. Furthermore, we report an unusual case of a 17-year-old man who sustained an isolated left-sided diaphragmatic rupture with visceral herniation as a result of low-velocity fall.
Results: 70% of the patients were males and the mean age was 39.1 years. The median injury severity score (ISS) was 32.9. Motor vehicle accidents (MVA) were the most frequent cause for BDR accounting for 89% of the cases. Left-sided diaphragmatic rupture occurred almost 3 times more often than right-sided. Diaphragm rupture is rarely seen as an isolated injury in blunt trauma. 95%-100% of patients with BDR have associated injuries including head injuries (30%), chest injuries (51%), pelvic fractures (39%), multiple rib fractures (46%), spleen injuries (42%), liver injuries (28%) and gut injuries (22%). Chest X-ray was diagnostic for BDR in 17%-61%, while CT had a sensitivity ranging between 82-100%. The death rate in our study was estimated to 21.6%.
Conclusion: BDR should be suspected in every case of blunt trauma even though most of the cases were related to high-velocity impact in MVA. A high index of clinical suspicion combined with repeated and selective radiologic evaluation is necessary for early diagnosis. Nevertheless, proper initial resuscitation and correction of other serious injuries may be more lifesaving in patients with BDR.