Traumatic diaphragmatic hernias: Retrospective analysis
Hérnias diafragmáticas traumáticas: Revisão casuística
1 Assistente Hospitalar Graduado/Graduate Hospital Assistant, Hospitais da Universidade de Coimbra
2 Assistente Hospitalar/Hospital Assistant, Hospitais da Universidade de Coimbra
3 Interno Complementar de Cirurgia Geral/General Surgery Intern, Hospitais da Universidade de Coimbra
4 Director de Serviço/Head of Department, Hospitais da Universidade de Coimbra
5 Serviço de Medicina Intensiva – Hospitais da Universidade de Coimbra
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Sousa, J.P. Baptista, L. Martins, J. Pimentel" "autores" => array:4 [ 0 => array:3 [ "nombre" => "J.P.A." "apellidos" => "Sousa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "J.P." "apellidos" => "Baptista" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "L." "apellidos" => "Martins" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">3</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Pimentel" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">4</span>" "identificador" => "aff0020" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">5</span>" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Assistente Hospitalar Graduado/<span class="elsevierStyleItalic">Graduate Hospital Assistant</span>, Hospitais da Universidade de Coimbra" "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Assistente Hospitalar/<span class="elsevierStyleItalic">Hospital Assistant</span>, Hospitais da Universidade de Coimbra" "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Interno Complementar de Cirurgia Geral/<span class="elsevierStyleItalic">General Surgery Intern</span>, Hospitais da Universidade de Coimbra" "etiqueta" => "<span class="elsevierStyleSup">3</span>" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Director de Serviço/<span class="elsevierStyleItalic">Head of Department, Hospitais da Universidade de Coimbra</span>" "etiqueta" => "<span class="elsevierStyleSup">4</span>" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Serviço de Medicina Intensiva – Hospitais da Universidade de Coimbra" "etiqueta" => "<span class="elsevierStyleSup">5</span>" "identificador" => "aff0025" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Hérnias diafragmáticas traumáticas: Revisão casuística" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2006-02-01" "fechaAceptado" => "2006-03-31" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key-words" "identificador" => "xpalclavsec158660" "palabras" => array:8 [ 0 => "Blunt trauma" 1 => "trauma" 2 => "chest trauma" 3 => "rupture of diaphragm" 4 => "abdominal trauma" 5 => "penetrating trauma" 6 => "visceral herniation" 7 => "mechanical ventilation" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec158661" "palabras" => array:8 [ 0 => "Trauma" 1 => "trauma torácico" 2 => "trauma abdominal" 3 => "ruptura diafragmática" 4 => "traumatismo fechado" 5 => "traumatismo aberto" 6 => "hérnia diafragmática" 7 => "ventilação mecânica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Aims</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">This study classifies cases of traumatic diaphragmatic hernias (TDH) in patients admitted to the Intensive Care Unit (ICU) of the Coimbra University Hospitals (HUC) from 1990 to 2004.</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Retrospective analysis of 34 cases of TDH, studying anatomical location, place and time of diagnosis, complementary tests aiding diagnosis, herniated organs, associated traumatism, morbidity and mortality.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Twenty-eight male and six female patients with an average age of 40.5 years<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>20.5, average SAPS score 38.8. Average lenght of stay was 19.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>13.6 days, all suffered from closed traumatism and were put on artificial ventilation. The left-side diaphragm was more frequently affected (94.1%) then the right. Diagnosis in 19 cases was made up in the first six hours following the diagnosis of traumatism, in four cases within 12 hours and in the remaining cases between 48 hours and 16 years after traumatism. In 13 patients the diagnosis was established intra-operatively. The stomach was typically one of the herniated organs. The most frequently associated lesions at the thoracic level were pulmonary contusion, haemothorax and pneumothorax, and at the abdominal level, haemoperitoneum and splenic lesion. The rates for complications and mortality were 55.8% and 11.7% respectively.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">TDH mainly occurs on the left side through closed thoraco-abdominal trauma following road traffic accidents. This group of patients, on average younger than others admitted to ICU, presents a longer average hospitalisation period, but has lower rates of mortality and lower SAPS severity scores. The most commonly herniated organ was the stomach and the most frequently encountered lesions were cranial-encephalic, splenic and pleural traumatisms. Pre-operative diagnosis of diaphragmatic injuries is difficult and a high index of clinical suspicion is needed after thoracoabdominal trauma. This diagnosis should always be considered a possibility in cases of closed thoraco-abdominal traumas.</p>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span class="elsevierStyleSectionTitle">Objectivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Os autores propuseram-se realizar uma revisão e caracterização dos casos de hérnias diafragmáticas (HD) traumáticas internados no Serviço de Medicina Intensiva dos Hospitais da Universidade de Coimbra (SMI-HUC) de 1990 a 2004.</p> <span class="elsevierStyleSectionTitle">Material e métodos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Análise retrospectiva de 34 casos de HD traumática, tendo em atenção a localização anatómica, o local e o momento do diagnóstico, os exames complementares que permitiram o diagnóstico, os órgãos herniados, os traumatismos associados, a morbilidade e a mortalidade.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Vinte e oito doentes eram do sexo masculino e 6 do feminino, com média de idades de 40,2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>20,5 anos; o valor médio do SAPS foi de 38,8. A duração média de internamento foi de 19,1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>13,6 dias, todos sofreram traumatismo fechado e foram submetidos a ventilação artificial. A hérnia localizava-se à esquerda em 94,1% dos casos. O diagnóstico em 19 dos casos foi efectuado até 6 horas após o traumatismo, em 4 casos até às 12 horas, e os restantes entre 48 horas e 16 anos após o traumatismo. Em 13 doentes o diagnóstico foi intra- operatório. Dos órgãos herniados, o estômago estava presente na maioria da situações. As lesões associadas mais frequentes foram, a nível torácico, a contusão pulmonar, o hemotórax e o pneumotórax, e a nível abdominal o hemoperitoneu e a lesão esplénica. A taxa de complicações e de mortalidade foi 55,8% e de 11,7%, respectivamente.</p> <span class="elsevierStyleSectionTitle">Conclusões</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A HD ocorreu maioritariamente à esquerda por traumatismo toraco-abdominal fechado na sequência de acidente de viação. Este grupo de doentes, em relação aos valores médios do Serviço, era mais jovem, apresentava maior duração média de internamento, apresentando, no entanto, menores taxa de mortalidade e índice de gravidade (SAPS). O órgão herniado mais frequente foi o estômago, e as lesões associadas mais encontradas foram os traumatismos crânio-encefálico, esplénico e pleuro-costal. A dificuldade de diagnóstico pré-operatória continua a requerer elevado grau de suspeição, exigindo-se sempre a colocação desta hipótese de diagnóstico no contexto de traumatismos toraco-abdominais fechados.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography/Bibliografia" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:27 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diaphragmatic injuries" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Beeson" 1 => "Z. Popovici" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Invited Comment in Thoracic Surgery: Surgical Management of Chest Injuries" "paginaInicial" => "317" "paginaFinal" => "322" "serieFecha" => "1991" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2." 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| Year/Month | Html | Total | |
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