Management approach for penetrating thoracoabdominal trauma
Keywords:
abdominal injuries, laparoscopy, penetrating, traumatic diaphragmatic hernia, thoracic injuries, wounds.Abstract
Introduction: Penetrating thoracoabdominal trauma presents significant diagnostic and therapeutic challenges, particularly in cases involving diaphragmatic involvement. Current literature reveals inconsistencies in defining this anatomical area and in determining the optimal diagnostic strategy.Objective: To analyze the literature and synthesize the most up-to-date key aspects for managing patients with penetrating thoracoabdominal trauma.
Methods: A search was conducted in indexed databases such as Web of Science, PubMed, Medline, Cochrane, SciElo, Lilacs, and Google Scholar, focusing on articles in English and Spanish published in the last 5 years. Out of an initial 154 articles, 40 were included based on specific criteria that addressed penetrating thoracoabdominal trauma.
Discussion: Physical examination should be the cornerstone in managing patients with thoracoabdominal trauma. Properly delineating this anatomical zone is crucial for making efficient use of available imaging aids, while being aware of their limitations. The threshold for making a surgical decision for diagnostic and therapeutic purposes should be low. Laparoscopy provides the advantage of identifying diaphragmatic injuries and correcting any intra-abdominal injuries as needed.
Conclusions: Penetrating thoracoabdominal trauma presents a broad clinical spectrum, with a particular challenge in hemodynamically stable patients due to the high morbidity and mortality associated with unnoticed diaphragmatic injuries. When such injuries are suspected, video surgery, particularly laparoscopy, is a crucial tool due to the limitations of conventional imaging studies.
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References
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30. De Jongh R, Koto MZ. Awake Emergency Department Thoracoscopic Investigation of Penetrating Diaphragmatic Injuries: A Novel Minimally Invasive Technique of Diagnosis [Internet]. J Laparoendosc Adv Surg Tech. 2020 [acceso: 16/12/2023]; 30(12):1334-9. Disponible en: https://www.liebertpub.com/doi/10.1089/lap.2020.0232
31. Koganti D, Hazen BJ, Dente CJ, Nguyen J, Gelbard RB. The role of diagnostic laparoscopy for trauma at a high-volume level one center [Internet]. Surg Endosc. 2021 [acceso: 11/03/2024]; 35(6):2667-70. Disponible en: https://link.springer.com/article/10.1007/s00464-020-07687-1
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2. Gillaspie D, Gillaspie EA. Management of Traumatic Diaphragmatic Injuries [Internet]. Thorac Surg Clin. 2024 [acceso: 05/07/2024]; 34(2):171-8. Disponible en: https://www.thoracic.theclinics.com/article/S1547-4127(24)00008-2/abstract
3. Quintero L, Melendez-Lugo JJ, Palacios-Rodríguez HE, Padilla N, Pino LF, García A, et al. Damage control in the emergency department, a bridge to life [Internet]. Colomb Medica. 2021 [acceso: 05/07/2024]; 52(2):e4004801. Disponible en: https://colombiamedica.univalle.edu.co/index.php/comedica/article/view/4801
4. Madden MR, Paull DE, Finkelstein JL, Goodwin CW, Marzulli V, Yurt RW, et al. Occult Diaphragmatic Injury from Stab Wounds to the Lower Chest and Abdomen [Internet]. J Trauma Inj Infect Crit Care. 1989 [acceso: 05/02/2024]; 29(3):292-8. Disponible en: https://journals.lww.com/jtrauma/abstract/1989/03000/occult_diaphragmatic-_injury_from_stab_wounds_to.3.aspx
5. Parreira JG, Rasslan S, Utiyama EM. Controversies in the Management of Asymptomatic Patients Sustaining Penetrating Thoracoabdominal Wounds [Internet]. Clinics. 2008 [acceso: 05/02/2024]; 63(5):695-700. Disponible en: https://www.sciencedirect.com/science/article/pii/S1807593222027545?via%3Dihub
6. Alizade E, Ilhan M, Durak G, Kaan Gok A, Ertekin C. Can invasive diagnostic methods be reduced by magnetic resonance imaging in the diagnosis of diaphragmatic injuries in left thoracoabdominal penetrating injuries? [Internet]. J Minimal Access Surg. 2022 [acceso: 05/01/2024]; 18(3):431. Disponible en: https://journals.lww.com/jmas/fulltext/2022/18030/can_invasive_diagnostic-_methods_be_reduced_by.17.aspx
7. Yucel M, Kulali F, Yildiz A. Development of Diaphragmatic Hernia in Patients with Penetrating Left Thoracoabdominal Stab Wounds [Internet]. World J Surg. 2022 [acceso: 02/02/2024]; 46(8):1872-7. Disponible en: https://onlinelibrary.wiley.com/doi/10.1007/s00268-022-06558-1
8. Furák J, Athanassiadi K. Diaphragm and transdiaphragmatic injuries [Internet]. J Thorac Dis. 2019 [acceso: 15/10/2023]; 11(S2):S152-7. Disponible en: https://jtd.amegroups.org/article/view/24885/19960
9. Bautista-Parada IR, Bustos-Guerrero AM. Prevalencia de lesiones torácicas y abdominales en pacientes con traumatismo toracoabdominal penetrante [Internet]. Cir Cir. 2022 [acceso: 28/11/2023]; 90(3):6871. Disponible en: https://www.cirugiaycirujanos.com/frame_esp.php?id=640
10. Abdellatif W, Chow B, Hamid S, Khorshed D, Khosa F, Nicolaou S, et al. Unravelling the Mysteries of Traumatic Diaphragmatic Injury: An Up-to-Date Review [Internet]. Can Assoc Radiol J. 2020 [acceso: 23/12/2023]; 71(3):313-21. Disponible en: https://journals.sagepub.com/doi/10.1177/0846537120905133
11. Menegozzo CAM, Damous SHB, Alves PHF, Rocha MC, Collet E Silva FS, Baraviera T, et al. "Pop in a scope": attempt to decrease the rate of unnecessary nontherapeutic laparotomies in hemodynamically stable patients with thoracoabdominal penetrating injuries [Internet]. Surg Endosc. 2020 [acceso: 18/10/2023]; 34(1):261-7. Disponible en: https://link.springer.com/article/10.1007/s00464-019-06761-7
12. Tibbitts R. Chapter 3: Thorax. En: Drake RL, Vogl W, Mitchell AWM, Tibbitts R, Richardson P, Horn A. Gray's atlas of anatomy. Third edition. Philadelphia, PA: Elsevier; 2021. p. 109-112.
13. Torchia M. Chapter 8: Body Cavities, Mesenteries, and Diaphragm. En: Moore KL. The developing human: clinically oriented embryology. Eleventh edition. Edinburgh; New York: Elsevier; 2020. p 284-285.
14. Xiao JC, Ma LY, Li BL. Late traumatic diaphragmatic rupture complicated by haemothorax and strangulation of the stomach: A case report [Internet]. J Int Med Res. 2020 [acceso: 18/07/2024]; 48(6):030006052093086. Disponible en: https://journals.sagepub.com/doi/10.1177/0300060520930864
15. Sekusky AL, Lopez RA. Diaphragm Trauma [Internet]. En: Hughes E, Rubio G. StatPearls. Treasure Island (FL): StatPearls Publishing; 2024. [acceso: 13/04/2024]. Disponible en: https://www.ncbi.nlm.nih.gov/books/NBK557647/
16. Liu Q, Luan L, Zhang G, Li B. Treatment of Chronic Traumatic Diaphragmatic Hernia Based on Laparoscopic Repair: Experiences From 23 Cases [Internet]. Front Surg. 2021 [acceso: 15/07/2024]; 8:706824. Disponible en: https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2021.706824/full
17. Higuchi S, Takahashi T, Kurokawa Y, Saito T, Yamamoto K, Momose K, et al. Laparoscopic repair of a traumatic diaphragmatic hernia with repeated colon incarcerations 7 years after injury: a case report [Internet]. Surg Case Rep. 2023 [acceso: 05/07/2024]; 9(1):212. Disponible en: https://surgicalcasereports.springeropen.com/articles/10.1186/s40792-023-01791-9
18. Giuffrida M, Perrone G, Abu-Zidan F, Agnoletti V, Ansaloni L, Baiocchi GL, et al. Management of complicated diaphragmatic hernia in the acute setting: a WSES position paper [Internet]. World J Emerg Surg. 2023 [acceso: 08/07/2024]; 18(1):43. Disponible en: https://wjes.biomedcentral.com/articles/10.1186/s13017-023-00510-x
19. Grimes OF. Traumatic injuries of the diaphragm. Am J Surg [Internet]. 1974 [acceso: 07/04/2024]; 128(2):175-81. Disponible en: https://www.americanjournalofsurgery.com/article/0002-9610(74)90090-7/abstract
20. Bosanquet D, Farboud A, Luckraz H. A review diaphragmatic injury [Internet]. Respir Med CME. [acceso: 01/02/2024] 2009; 2(1):1-6. Disponible en: https://www.sciencedirect.com/science/article/pii/S1755001709000037
21. Hodler J, Kubik-Huch RA, von Schulthess GK, editores. Diseases of the Chest, Breast, Heart and Vessels 2019-2022: Diagnostic and Interventional Imaging [Internet]. Cham (CH): Springer; 2019. [acceso: 13/04/2024]. (IDKD Springer Series). Disponible en: http://www.ncbi.nlm.nih.gov/books/NBK553871/
22. Scumpia A, Aronovich D, Roman L, Vasudevan V, Shadis R, Lynn M. Diaphragmatic Rupture Secondary to Blunt Thoracic Trauma [Internet]. West J Emerg Med. 2013 [acceso: 12/01/2024]; 14(5):435-6. Disponible en: https://escholarship.org/uc/item/63n4q0nq
23. Reitano E, Cioffi SPB, Airoldi C, Chiara O, La Greca G, Cimbanassi S. Current trends in the diagnosis and management of traumatic diaphragmatic injuries: A systematic review and a diagnostic accuracy meta-analysis of blunt trauma [Internet]. Injury. 2022 [acceso: 17/03/2024]; 53(11):3586-95. Disponible en: https://www.injuryjournal.com/article/S0020-1383(22)00458-2/abstract
24. Boussuges A, Rives S, Finance J, Brégeon F. Assessment of diaphragmatic function by ultrasonography: Current approach and perspectives [Internet]. World J Clin Cases. 2020 [acceso: 19/03/2024]; 8(12):2408-24. Disponible en: https://www.wjgnet.com/2307-8960/full/v8/i12/2408.htm
25. Stengel D, Leisterer J, Ferrada P, Ekkernkamp A, Mutze S, Hoenning A. Point-of-care ultrasonography for diagnosing thoracoabdominal injuries in patients with blunt trauma. Cochrane Injuries Group, editor. Cochrane Database Syst Rev [Internet]. 2018 [acceso: 13/04/2024]; 12(12):CD012669. Disponible en: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012669.pub2/full/es
26. Sharifi A, Kasraianfard A, Chavoshi Khamneh A, Kanani S, Aldarraji M, Seif-Rabiei MA, et al. Value of Ultrasonography in Detection of Diaphragmatic Injuries Following Thoracoabdominal Penetrating Trauma; a Diagnostic Accuracy Study [Internet]. Arch Acad Emerg Med. 2019 [acceso: 12/03/2024]; 7(1):e45. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6785213/
27. Ashoobi MA, Homaie Rad E, Rahimi R. Diagnostic performance of sonography in penetrating torso trauma: a systematic review and meta-analysis. Eur J Trauma Emerg Surg [Internet]. 2024. [acceso: 01/07/2024]. Disponible en: https://link.springer.com/10.1007/s00068-024-02446-6
28. Hassankhani A, Amoukhteh M, Valizadeh P, Jannatdoust P, Eibschutz LS, Myers LA, et al. Diagnostic utility of multidetector CT scan in penetrating diaphragmatic injuries: A systematic review and meta-analysis [Internet]. Emerg Radiol. 2023 [acceso: 08/06/2024]; 30(6):765-76. Disponible en: https://link.springer.com/article/10.1007/s10140-023-02174-1
29. Habashi R, Coates A, Engels PT. Selective nonoperative management of penetrating abdominal trauma at a level 1 Canadian trauma centre: a quest for perfection [Internet]. Can J Surg. 2019 [acceso: 19/02/2024]; 62(5):347-55. Disponible en: https://www.canjsurg.ca/content/62/5/347
30. De Jongh R, Koto MZ. Awake Emergency Department Thoracoscopic Investigation of Penetrating Diaphragmatic Injuries: A Novel Minimally Invasive Technique of Diagnosis [Internet]. J Laparoendosc Adv Surg Tech. 2020 [acceso: 16/12/2023]; 30(12):1334-9. Disponible en: https://www.liebertpub.com/doi/10.1089/lap.2020.0232
31. Koganti D, Hazen BJ, Dente CJ, Nguyen J, Gelbard RB. The role of diagnostic laparoscopy for trauma at a high-volume level one center [Internet]. Surg Endosc. 2021 [acceso: 11/03/2024]; 35(6):2667-70. Disponible en: https://link.springer.com/article/10.1007/s00464-020-07687-1
32. Jaime Restrepo C, Fidel Cano R. Exploración Digital en Heridas del Diafragma [Internet]. Rev Colomb Cir. 1987 [acceso: 14/03/2024]; 2(1):41-4. Disponible en: https://www.revistacirugia.org/index.php/cirugia/article/view/1901
33. Morales CH. Value of Digital Exploration for Diagnosing Injuries to the Left Side of the Diaphragm Caused by Stab Wounds [Internet]. Arch Surg. 2001 [acceso: 13/09/2023]; 136(10):1131. Disponible en: https://jamanetwork.com/journals/jamasurgery/fullarticle/392192
34. Khazaei A, Dahmardehei M, Narouie B, Beiraghi-Toosi A. Determination of efficacy of physical examination in the diagnosis diaphragmatic injuries due to stab wound to lower thoracic area confirmed with thoracoscopy [Internet]. Life Sci J. 2012 [acceso: 19/02/2023]; 9:1527-31. Disponible en: https://www.lifesciencesite.com/lsj/life0903/222_9142life0903_1527_1531.pdf
35. Wang J, Cheng L, Liu J, Zhang B, Wang W, Zhu W, et al. Laparoscopy vs. Laparotomy for the Management of Abdominal Trauma: A Systematic Review and Meta-Analysis [Internet]. Front Surg. 2022 [acceso: 10/04/2024]; 9:817134. Disponible en: https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2022.817134/full
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Published
2024-10-26
How to Cite
1.
Jaramillo Escobar SL, Castaño Cardona AL. Management approach for penetrating thoracoabdominal trauma. Rev Cubana Med Milit [Internet]. 2024 Oct. 26 [cited 2025 Apr. 3];53(4):e024056112. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/56112
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