BACKGROUND: Diaphragmatic injury in trauma is uncommon, but it is a clinical entity with lifethreatening condition and high incidence of associated injuries. AIM: To demonstrate the effectiveness of thoracic washing through thoracotomy or thoracic drainage alone in wounds with diaphragmatic injury associated to gastrointestinal perforations. METHODS: Prospective study in patients admitted in the trauma unit of the Restauração Hospital (Recife PE, Brasil) between April /2004 and September/2006. All the patients were adult (> 13 years) and victims of penetrating wounds associated with digestive and diaphragmatic injuries. The patients were divided in two groups according to surgical treatment: thoracic washing through thoracotomy and simple thoracic drainage. RESULTS: Ninety-two patients were selected. The medium age was 26,6 years. There were 73 gunshot injuries and 19 stabs. The Revised Trauma Score (RTS) varied from 7,28 to 7,55. Thoracic washing was used in 13 patients. Forty-six patients (50%) suffered injuries in right hemidiaphragm; 37 (40.21%) in left and 9 bilateral (9.78%). Pulmonary atelectasis, pleural effusion and mediastinal infection were more frequent in the drainage group. Respiratory insufficiency, pulmonary imprisonment and pleural empiema were more frequent in washing group. CONCLUSIONS: Higher morbidity occurred with thoracic washing patients when compared to the ones submitted to simple drainage procedure.
Diaphragmatic trauma; Emergency surgery; Digestive system; Postoperative complications
