Diaphragmatic injuries due to stab wounds: analysis of 18 patients

Abstract

Purpose: Although all diaphragmatic injuries caused by stab wounds need to be repaired, preoperative diagnosis is often difficult. The purpose of the present study is to share our experience regarding diaphragmatic wounds.

Patients and Methods: Eighteen patients with stab wounds causing diaphragmatic injuries treated at General Surgery Clinic of İnönü University Faculty of Medicine between March 2000 and June 2009 were evaluated retrospectively.

Results: There were 15 male and 3 female patients with mean age of 33 (20-69) years. Most common complaints were difficulty in breathing, and abdominal and chest pain. Localization of the injury was on the left side of the diaphragm in 11 (61%) patients and on the right side in 6 (33%) patients, and one (6%) patient had injuries on both sides. Surgery was performed in 17 patients with midline abdominal incision within the first 24 hours after the injury and with lateral thoracotomy in a patient 10 days after injury. Mortality occurred in 3 (17%) patients; in 2 patients due to bleeding from accompanying injuries and in one patient due to postoperative sepsis.

Conclusion: Preoperative diagnosis of diaphragmatic injury due to a stab wound is difficult. These patients highly probably have visceral organ injuries in addition to diaphragmatic injuries. Diaphragmatic injuries should be kept in mind in patients with abdominal penetrating stab injuries which are located between umbilicus and xiphoid. Both hemidiaphragms should be explored carefully during abdominal surgery of these patients.