Thoracoscopic examination of the thoracic cavity during laparotomy in traumatic diaphragm injuries

Background: Traumatic diaphragmatic injury (TDI) is one of the injuries that can occur after blunt and penetrating trauma and can be neglected or missed due to the masking of accompanying organ injuries. In this study, we delved into the difficulties in the diagnostic and treatment approaches for TDI patients. Methods: We retrospectively examined 22 TDI cases who were urgently operated following blunt (n = 14) and penetrating (n = 8) traumas in thoracic and general surgery clinics between January 2004 and 2019. We recorded information such as trauma type, diagnostic techniques, concomitant organ injuries, the location of diaphragmatic injury and its stage, the herniated organs toward the chest cavity, and surgical method. Results: The average mean age of the cases in the study was 41.5 years (22–66 years), and all of them were male. Among these, the percentage of pericardial rupture was significant (23%). In abdominal approaches, thorax was examined with an optical camera through the diaphragmatic rupture. TDI was classified into five groups based on the severity of the injury. Additionally, diaphragmatic ruptures in the central tendon or subpericardial area were examined. The entire central diaphragmatic injury was found as blunt trauma. This group was diagnosed with a high rate of multiple organ injuries (100%) and pericardial rupture (30%). Morbidity was 36%, and mortality was 14%. Conclusion: TDI should be taken into consideration in thoracoabdominal traumas. The frequency of organ injury in high-level TDI is also high. Therefore, laparoscopic and thoracoscopic evaluations should be needed. A good preoperative and peroperative strategy diminishes mortality and morbidity. We suggest that laparoscopy and thoracoscopy will be a lifesaving method in high-grade TDIs.