Laparoscopy is sufficient to exclude occult diaphragm injury after penetrating abdominal trauma

Randall S Friese, C. Eric Coln, Larry M. Gentilello

Research output: Contribution to journalArticle

79 Citations (Scopus)

Abstract

Background: Occult diaphragm injury after penetrating tnoracoabdominal injury can be difficult to diagnose and can remain occult for months to years. Delayed diagnosis is associated with the risk of hernia formation, strangulation, and high morbidity and mortality. Although laparoscopy has been proposed as a means of evaluating the diaphragm in these patients, prior studies did not include a confirmatory procedure or did not report long-term follow-up. Thus, true sensitivity and specificity remain unknown. The purpose of this study was to determine the sensitivity and specificity of laparoscopy for the detection of diaphragm injury after penetrating thoracoabdominal trauma. We hypothesized that laparoscopy alone is sufficient to exclude diaphragm injury after penetrating thoracoabdominal trauma. Methods: We conducted a prospective case series of 34 hemodynamically normal asymptomatic patients with thoracoabdominal penetrating injuries. All patients underwent diagnostic laparoscopy to evaluate the diaphragm for the presence of injury. All patients then underwent confirmatory celiotomy (n = 30) or video-assisted thoracoscopy (n = 4). Results: All patients were men between the ages of 18 and 54 years. There were 37 stab wounds and 1 gunshot wound. The mean lowest preoperative systolic blood pressure recorded was 120 ± 18 mm Hg. Penetrating injuries were stratified by anatomic location (anterior, 18; posterior, 8; flank, 9; not specified, 3). There were 7 true-positive, 30 true-negative, no false-positive, and 1 false-negative result. Specificity, sensitivity, and negative predictive value were 100%, 87.5%, and 96.8%, respectively. The single missed injury occurred in a patient with hemoperitoneum from associated splenic injury that obscured the diaphragm and warranted celiotomy. Conclusion: In asymptomatic hemodynamically normal patients with penetrating thoracoabdominal injury, laparoscopy alone is sufficient to exclude diaphragmatic injury.

Original languageEnglish (US)
Pages (from-to)789-792
Number of pages4
JournalJournal of Trauma
Volume58
Issue number4
DOIs
StatePublished - Apr 2005
Externally publishedYes

Fingerprint

Diaphragm
Laparoscopy
Wounds and Injuries
Sensitivity and Specificity
Blood Pressure
Hemoperitoneum
Stab Wounds
Gunshot Wounds
Thoracoscopy
Delayed Diagnosis
Hernia
Morbidity

Keywords

  • Laparoscopy
  • Thoracoabdominal
  • Trauma

ASJC Scopus subject areas

  • Surgery

Cite this

Laparoscopy is sufficient to exclude occult diaphragm injury after penetrating abdominal trauma. / Friese, Randall S; Coln, C. Eric; Gentilello, Larry M.

In: Journal of Trauma, Vol. 58, No. 4, 04.2005, p. 789-792.

Research output: Contribution to journalArticle

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AB - Background: Occult diaphragm injury after penetrating tnoracoabdominal injury can be difficult to diagnose and can remain occult for months to years. Delayed diagnosis is associated with the risk of hernia formation, strangulation, and high morbidity and mortality. Although laparoscopy has been proposed as a means of evaluating the diaphragm in these patients, prior studies did not include a confirmatory procedure or did not report long-term follow-up. Thus, true sensitivity and specificity remain unknown. The purpose of this study was to determine the sensitivity and specificity of laparoscopy for the detection of diaphragm injury after penetrating thoracoabdominal trauma. We hypothesized that laparoscopy alone is sufficient to exclude diaphragm injury after penetrating thoracoabdominal trauma. Methods: We conducted a prospective case series of 34 hemodynamically normal asymptomatic patients with thoracoabdominal penetrating injuries. All patients underwent diagnostic laparoscopy to evaluate the diaphragm for the presence of injury. All patients then underwent confirmatory celiotomy (n = 30) or video-assisted thoracoscopy (n = 4). Results: All patients were men between the ages of 18 and 54 years. There were 37 stab wounds and 1 gunshot wound. The mean lowest preoperative systolic blood pressure recorded was 120 ± 18 mm Hg. Penetrating injuries were stratified by anatomic location (anterior, 18; posterior, 8; flank, 9; not specified, 3). There were 7 true-positive, 30 true-negative, no false-positive, and 1 false-negative result. Specificity, sensitivity, and negative predictive value were 100%, 87.5%, and 96.8%, respectively. The single missed injury occurred in a patient with hemoperitoneum from associated splenic injury that obscured the diaphragm and warranted celiotomy. Conclusion: In asymptomatic hemodynamically normal patients with penetrating thoracoabdominal injury, laparoscopy alone is sufficient to exclude diaphragmatic injury.

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