• Journal of Chest Surgery
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• 제28권1호
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• pp.47-52
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• 1995

We have experienced 30 cases of traumatic diaphragm injury between January,1988 and August,1993. 30 cases were reviewed and following results were obtained. 1.Sex ratio is 22:8 with male dominance. 2.The 27 cases were due to blunt trauma and other 3 cases were due to penetrating injury. 3.Left side injury was more common than right[24:6 . 4.The most common herniated abdominal organ was the stomach 5.Mortality rate was 27% and its causes were not diaphragmatic injury itself,but other associated multiple organ injury.

• Journal of Chest Surgery
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• 제27권3호
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• pp.255-258
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• 1994

I have experienced with 6 cases traumatic injury of diaphragm from May 1991 to October 1993 at the Youngdong Hospital in Tonghae. This cases included 4 penetrating injuries and 2 nonpenetrating injuries. Associated injuries occurred 4 cases and 2 cases occurred stomach herniation. All cases, operative treatment were done. Result of this treatment cases were good. Complications included 1 early death and only 1 wound infection. Cause of death was related to associated injury.

• Journal of Korean Neurosurgical Society
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• 제57권2호
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• pp.131-134
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• 2015

Traumatic diaphragm hernia can occur in rare cases and generally accompanies thoracic or abdominal injuries. When suffering from ankylosing spondylitis, a small force can develop into vertebral fracture and an adjacent structural injury, and lead to diaphragm hernia without accompanying concomitant thoracoabdominal injury. A high level of suspicion may be a most reliable diagnostic tool in the detection of a diaphragm injury, and we need to keep in mind a possibility in a patient with ankylosing spondylitis and a thoracolumbar fracture, even in the case of minor trauma.

• Journal of Chest Surgery
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• 제27권2호
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• pp.148-152
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• 1994

We have experienced 21 cases of traumatic diaphragm injury between October, 1989 and September, 1993. Of these patients, 17 cases were caused by blunt trauma and 4 by penetrating injury. Among 17 blunt traumas, 10 cases developed at left side, 6 at right and 1 at central subpericardial diaphragm, and among penetrating injuries, 3 cases developed at right side and 1 at left. Overall mortality rate was 21% and one due to blunt trauma was 29%. Initial hypotension was a predisposing factor to presume future death. When associated injuries involved 4 or more organs, mortality rate was high.

• Journal of Chest Surgery
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• 제25권10호
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• pp.1001-1012
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• 1992

13 cases of traumatic diaphragmatic ruptures were treated at the department of thoracic and cardiovascular surgery in Lee-Rha general hospital, Cheong-Ju, Choong Cheong Buk Do, between Oct. 1989 and Feb. 1992. The above 13 cases were reviewed in this study. And the following results were obtained. 1. Sex ratio is 11: 2 with male dominance 2. The 9 cases were due to blunt trauma and other 4 cases were due to penetrating injury. 3. Right side injury was more common than left[7: 5] and there was 1 case of central type which ruptured through subepicardial diaphragm. 4. All of the cases had association injury. 5. Preoperative diagnosis was possible in the 9 cases and others were diagnosed during operation under other indication. 6. Finger exploration was one of effective diagnostic procedure. 7. All of diaphragmatic ruptures was corrected through thoracotomy and exploratory laparotomy was done in 6 cases. 8. A patient died after operation due to associated injuries.

• Journal of Trauma and Injury
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• 제31권1호
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• pp.19-23
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• 2018

Traumatic diaphragmatic rupture is an unusual finding that may occur after blunt trauma. In addition, diaphragmatic rupture occurring bilaterally is extremely rare. We experienced a 6-year-old boy with bilateral diaphragmatic rupture, whom survived after surgical treatment by open thoracotomy but, complicated with spinal cord injury discovered after surgery.

• Journal of Trauma and Injury
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• 제30권1호
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• pp.16-20
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• 2017

A 48-year-old man came to the emergency department with altered consciousness and hemoperitoneum following a pedestrian traffic accident. He underwent immediate emergency laparotomy, and on the second day, he required craniectomy because of increase of intracranial hemorrhage. A chest radiograph taken 7 days after admission, showed elevation of the right hemi-diaphragm, and follow-up chest CT showed a right-sided rupture of the diaphragm, which was surgically repaired. Rupture of the diaphragm can be easily overlooked and the diagnosis delayed, especially in unstable patients with multiple trauma or altered level of consciousness, as in the case reported here.

• Journal of Trauma and Injury
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• 제32권2호
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• pp.122-125
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• 2019

A 73-year-old man, who, in an inebriated state, had slipped in a flowerbed and was wounded on the left flank, was transferred to Trauma Center, Gil Medical Center, Gachon University College of Medicine. Based on the chest and abdominopelvic computed tomography, he was diagnosed with multiple rib fractures and hemopneumothorax on the left hemithorax and was found to have a bony fragment in the spleen. He had not presented peritonitis and exsanguinous symptoms during the observation period. Seven days later, computed tomography of the abdomen showed suspected diaphragmatic injury and a retained foreign body in the spleen. On exploration by video assisted thoracoc surgery (VATS), a herniated omentum through the lacerated site of the diaphragm was observed. After omentectomy using Endo Gia, the foreign body in the spleen was observed through the lacerated site of the diaphragm. Traumatic diaphragm rupture with a foreign body, in the spleen, was successfully managed by video assisted thoracic surgery via the lacerated site of the diaphragm.

• Journal of Trauma and Injury
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• 제32권1호
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• pp.66-70
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• 2019

Traumatic diaphragmatic injuries (TDIs) are a rare complication in thoraco-abdominal trauma. The diagnosis is difficult and if left untreated, TDI can cause traumatic diaphragmatic hernia (TDH). Through an injured diaphragm, the liver, spleen, stomach, small intestine, and large intestine can be herniated to the thoracic cavity, but pancreatic herniation and pancreatitis are quite rare in TDH. This paper reports a case of pancreatitis developed by additional trauma in a patient with asymptomatic chronic TDH. A 58-year-old male visited the emergency department with a left abdominal injury after a fall 6 hours earlier. The vital signs were stable, but the amylase and lipase levels were elevated to 558 U/L and 1,664 U/L, respectively. Abdominal computed tomography (CT) revealed a left diaphragmatic hernia and an incarceration of the stomach, pancreatic ductal dilatation, and peripancreatic fatty infiltration. Additional history taking showed that he had suffered a fall approximately 20 years ago and had an accidentally diaphragmatic hernia through a chest CT 6 months earlier. A comparison with the previous CT revealed the pancreatitis to be caused by secondary pancreatic ductal obstruction due to the incarcerated stomach. For pancreatitis, gastrointestinal decompression was performed, and after 3 days, the pancreatic enzyme was normalized; hence, a thoracotomy was performed. A small ruptured diaphragm was found and reposition of the organs was performed. This paper reports the experience of successfully treating pancreatitis and pancreatic hernia developed after trauma without complications through a thoracotomy following gastrointestinal decompression.

• Journal of Chest Surgery
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• 제38권1호
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• pp.56-62
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• 2005

외상성 횡격막 손상은 진단이 어렵고, 치료가 늦어지는 경우 치명적일 수 있다. 본 연구는 외상성 횡격막 손상 환자들의 임상적 특징과 예후 예측 인자로서 외상 지표들의 유용성을 알아보고자 하였다. 대상 및 방법: 1995년 5월부터 2003년 6월까지 3차 의료기관에서 외상성 횡격막 손상으로 진단받은 23명의 성인 환자를 대상으로 하였다. 이 환자들의 Revised Trauma Score (RTS)와 Injtry Severity Score (ISS), Trauma and Injury Severity Score (TRISS), Acute Physical and Chronic Health Evaluation (APACHE) II점수를 구하여 사망여부 및 중환자실 입원기간과의 관계를 분석하였다. 결과: 손상 기전은 둔상 14명$(60.9{\%})$, 관통상 9명$(39.1{\%})$이었으며, 손상부위는 우측 11명($47.8{\%}$), 좌측 11명($47.8{\%}$), 양측 1명($4.4{\%}$)이었다. 15명($65.2{\%}$)의 환자에 대해서는 손상 후 24시간 이내에 진단이 이루어졌으며, 14명$(60.9{\%})$은 수술 전에 진단받았다. 진단 방법으로는 단순 흥부방사선 촬영, 전산화 단층촬영, 상부위장관 조영술과 위내시경을 사용하였으며, 단순 흉부방사선 촬영으로 의심한 경우는 9명$(39.1{\%})$이었다. 23명중 2명$(8.7{\%})$이 사망하였다. 결과 예측을 위해 환자의 나이, 수술 전까지 쇼크의 유무, 손상된 시간으로부터 수술까지의 시간과 사망 여부를 비교해 보았는데, 통계학적으로 유의할 만한 연관을 보이지 않았다. RTS와 ISS는 사망과 연관을 보였으나, TRISS나 APACHE II 점수는 연관을 보이지 않았다. 중환자실 재원 기간과 외상 지표들과의 상관관계를 분석한 결과, 중환자실 재원 기간은 RTS 점수가 높을수록 짧아지고(r: -0.501, p=0.000), APACHE II 점수가 높을수록 길어지는 경향을 보였다(r=0.737, p=0.026). 결론: 다발성 외상 환자를 진료함에 있어 외상성 횡격막 손상의 가능성을 의심하고 접근하는 것이 중요하며, 그 중증도와 예후를 예측하는 데 RTS가 간단하고 비교적 뛰어난 외상지표로 사용될 수 있을 것이다.