Controversies in the management of asymptomatic patients sustaining penetrating thoracoabdominal wounds

Authors

  • Jose Gustavo Parreira Universidade de São Paulo; Faculdade de Medicina; Hospital das Clínicas; Department of Surgery
  • Samir Rasslan Universidade de São Paulo; Faculdade de Medicina; Hospital das Clínicas; Department of Surgery
  • Edivaldo M. Utiyama Universidade de São Paulo; Faculdade de Medicina; Hospital das Clínicas; Department of Surgery

DOI:

https://doi.org/10.1590/S1807-59322008000500020

Keywords:

Diaphragmatic injury, Videolaparoscopy, Videothoracoscopy, Thoracic trauma, Diaphragmatic hernia

Abstract

The most challenging diagnostic issue in the management of thoracoabdominal wounds concerns the assessment of asymptomatic patients. In almost one-third of such cases, diaphragmatic injuries are present even in the absence of any clear clinical signs. The sensitivity of noninvasive diagnostic tests is very low in this situation, and acceptable methods for diagnosis are limited to videolaparoscopy or videothoracoscopy. However, these procedures are performed under general anesthesia and present real, and potentially unnecessary, risks for the patient. On the other hand, diaphragmatic hernias, which can result from unsutured diaphragmatic lesions, are associated with considerable morbidity and mortality. In this paper, the management of asymptomatic patients sustaining wounds to the lower chest is discussed, with a focus on the diagnosis of diaphragmatic injuries and the necessity of suturing them.

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Published

2008-01-01

Issue

Section

Review Articles

How to Cite

Parreira, J. G., Rasslan, S., & Utiyama, E. M. (2008). Controversies in the management of asymptomatic patients sustaining penetrating thoracoabdominal wounds . Clinics, 63(5), 695-700. https://doi.org/10.1590/S1807-59322008000500020