Tehran University Medical Journal

Background: Penetrating thoracoabdominal stab wounds may cause diaphragmatic and abdominal organ laceration. However, 15-20% of these cases who are stable and managed by conservative treatment might have hidden diaphragmatic injuries, which could ultimately lead to chronic diaphragmatic hernia. Therefore, a safe and exact diagnostic method for the detection of occult diaphragmatic injuries is very valuable. In this study we have assessed the diagnostic value of thoracoscopy in occult diaphragmatic injuries resulting from penetrating thoracoabdominal stab wounds.

Methods: From March 2005 to October 2007, 30 hemodynamically stable patients with penetrating thoracoabdominal injuries, not requiring emergent exploration, were enrolled in this study. All subjects underwent thoracoscopy to evaluate probable diaphragmatic injury. Diaphragmatic injuries were repaired via thoracoscopy or laparatomy. All patients were evaluated for chronic diaphragmatic hernia by CT-scan six months later.

Results: The mean patient age was 26.2 years, with a male/female ratio of 5:1. Using thoracoscopic exploration, we observed five (16.7%) hidden diaphragmatic injuries, three (9.9%) of which were repaired using the thoracoscopic approach and two (6.6%) by laparatomy. Lung parenchymal laceration was seen in two patients (6.6%), for whom the repair was performed using thoracoscopy. Intra-abdominal injury was seen in one patient (3.3%), which was repaired by laparatomy. After thoracoscopy, there were no complications or evidence of chronic diaphragmatic hernia in the chest and abdominal CT-scans performed six months later. Therefore, the diagnostic accuracy of thoracoscopy in occult diaphragmatic injuries in our study was 100%.

Conclusion: With its high degree of diagnostic accuracy, low degree of invasiveness, as well as its utility in treatment, we recommend thoracoscopy for all clinically stable patients with penetrating thoracoabdominal stab wounds.

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Empyema is one of the most common and important thoracic diseases which can lead to some sort of debilitating consequences if does not managed properly. Surgery usually is indicated in the third stage of the disease which contains more and devastating complications that do not respond to the other treatment options. This investigation evaluates the role of thoracoscopy (minimal invasive surgical intervention) in the management of second stage of empyema.
Methods: In a prospective investigation, 54 patients with stage II of empyema were selected and divided in two groups. In control group, patients were treated with chest tube thoracic drainage plus antibiotics administration, on the other side, Thoracoscopic diagnosis and drainage was added to the modalities of the control group. Thoracoscopy is aimed to explore the total thoracic cavity for releasing the fibrous bands and adhesions and draining of the loculated abscess. At the end of procedure plural cavity wash out and chest tube insertion were done.
Results: The rate of complication was 35% and 8% (p<0.05) in control group and investigated group, respectively. The average admission days were significantly greater in control group (the investigated group got better faster) (p<0.05). The need for thoracotomy was 7 time greater in control group (p<0.05).
Conclusion: Application of Thoracoscopy for stage 2 of empyema is a safe modality which can be advised for all of the patients. This minimally invasive technique can decrease complications rate, need for thoracotomy and hospital admission time.