%0 Journal Article
%T Blunt traumatic diaphragmatic rupture Rotura diafragm¨¢tica no trauma abdominal fechado
%A Antonio Carlos Nogueira
%A Munir Bazzi
%A Francisco Garcia Soriano
%A Hayd¨¦e Jord£¿o
%J Autopsy and Case Reports
%D 2011
%I University of S?o Paulo
%X 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 incid¨ºncia de les o traum¨¢tica do diafragma, relatada na literatura, varia de 0,6 a 1,2% dentre os pacientes v¨ªtimas de traumas, elevando-se para 5% nos pacientes com trauma fechado submetidos a laparotomia. A suspeita cl¨ªnica associada ¨¤ avalia  o radiol¨®gica contribui para o diagn¨®stico precoce. A les o diafragm¨¢tica isoladamente ¨¦ de bom progn¨®stico. Assim, em geral, as les es associadas ¨¤ rotura diafragm¨¢tica s o os preditores da pior evolu  o do paciente. As les es do diafragma direito e as les es bilaterais apresentam pior progn¨®stico. A tomografia computadorizada com multidetectores (MDCT) de t¨®rax oferece a possibilidade de reconstru  o multiplanar permitindo melhor acur¨¢cia no diagn¨®stico. A corre  o cir¨²rgica por meio de laparotomia e/ou toracotomia na fase aguda do trauma apresenta boa evolu  o e evita as complica  es cr nicas da h¨¦rnia diafragm¨¢tica. Os autores apresentam o caso de um paciente jovem do sexo masculino, v¨ªtima de trauma abdominal fechado por acidente automobil¨ªstico que apresentou rotura do diafragma, les o espl¨ºnica e renal. O diagn¨®stico foi feito atrav¨¦s da tomografia computadorizada de t¨®rax e abdome e confirmada durante laparotomia exploradora.
%K Diafragma
%K H¨¦rnia
%K Laparotomia
%K Ferimentos e les es.
%U http://www.revistas.usp.br/autopsy/article/view/26066