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Blunt traumatic diaphragmatic rupture Rotura diafragmática no trauma abdominal fechado

Keywords: Diafragma , Hérnia , Laparotomia , Ferimentos e les es.

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Abstract:

Traumatic injury of the diaphragm ranges from 0.6 to 1.2% and rise up to 5% among patients who were victims of blunt trauma and underwent laparotomy. Clinical suspicion associated with radiological assessment contributes to early diagnosis. Isolated diaphragmatic injury has a good prognosis. Generally worse outcomes are associated with other trauma injuries. Bilateral and right diaphragmatic lesions have worse prognosis. Multi detector computed tomography (MDCT) scan of the chest and abdomen provides better diagnostic accuracy using the possibility of image multiplanar reconstruction. Surgical repair via laparotomy and/ or thoracotomy in the acute phase of the injury has a better outcome and avoids chronic complications of diaphragmatic hernia. The authors present the case of a young male patient, victim of blunt abdominal trauma due to motor vehicle accident with rupture of the diaphragm, spleen and kidney injuries. The diagnosis was made by computed tomography of the thorax and abdomen and was confirmed during laparotomy. A incidência de les o traumática do diafragma, relatada na literatura, varia de 0,6 a 1,2% dentre os pacientes vítimas de traumas, elevando-se para 5% nos pacientes com trauma fechado submetidos a laparotomia. A suspeita clínica associada à avalia o radiológica contribui para o diagnóstico precoce. A les o diafragmática isoladamente é de bom prognóstico. Assim, em geral, as les es associadas à rotura diafragmática s o os preditores da pior evolu o do paciente. As les es do diafragma direito e as les es bilaterais apresentam pior prognóstico. A tomografia computadorizada com multidetectores (MDCT) de tórax oferece a possibilidade de reconstru o multiplanar permitindo melhor acurácia no diagnóstico. A corre o cirúrgica por meio de laparotomia e/ou toracotomia na fase aguda do trauma apresenta boa evolu o e evita as complica es cr nicas da hérnia diafragmática. Os autores apresentam o caso de um paciente jovem do sexo masculino, vítima de trauma abdominal fechado por acidente automobilístico que apresentou rotura do diafragma, les o esplênica e renal. O diagnóstico foi feito através da tomografia computadorizada de tórax e abdome e confirmada durante laparotomia exploradora.

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