Original Articles
Traumatic Rupture of the Diaphragm
J. Cerón Navarro
, J.C. Peñalver Cuesta, J. Padilla Alarcón, C. Jordá Aragón, J. Escrivá Peiró, V. Calvo Medina, A. García Zarza, J. Pastor Guillem, E. Blasco Armengod
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ceronjs@yahoo.es
Correspondence: Dr J. Cerón Navarro Servicio de Cirugía Torácica, Hospital Universitario La Fe Avda. Campanar, 21 46009 Valencia, Spain
Correspondence: Dr J. Cerón Navarro Servicio de Cirugía Torácica, Hospital Universitario La Fe Avda. Campanar, 21 46009 Valencia, Spain
Servicio de Cirugía Torácica, Hospital Universitario La Fe, Valencia, Spain
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Cerón Navarro, J.C. Peñalver Cuesta, J. Padilla Alarcón, C. Jordá Aragón, J. Escrivá Peiró, V. Calvo Medina, A. García Zarza, J. Pastor Guillem, E. Blasco Armengod" "autores" => array:9 [ 0 => array:4 [ "nombre" => "J. Cerón" "apellidos" => "Navarro" "email" => array:1 [ 0 => "ceronjs@yahoo.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 1 => array:2 [ "nombre" => "J.C. Peñalver" "apellidos" => "Cuesta" ] 2 => array:2 [ "nombre" => "J. Padilla" "apellidos" => "Alarcón" ] 3 => array:2 [ "nombre" => "C. Jordá" "apellidos" => "Aragón" ] 4 => array:2 [ "nombre" => "J. Escrivá" "apellidos" => "Peiró" ] 5 => array:2 [ "nombre" => "V. Calvo" "apellidos" => "Medina" ] 6 => array:2 [ "nombre" => "A. García" "apellidos" => "Zarza" ] 7 => array:2 [ "nombre" => "J. Pastor" "apellidos" => "Guillem" ] 8 => array:2 [ "nombre" => "E. Blasco" "apellidos" => "Armengod" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Cirugía Torácica, Hospital Universitario La Fe, Valencia, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence: Dr J. Cerón Navarro Servicio de Cirugía Torácica, Hospital Universitario La Fe Avda. Campanar, 21 46009 Valencia, Spain" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2007-04-12" "fechaAceptado" => "2007-10-16" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec155220" "palabras" => array:8 [ 0 => "<span class="elsevierStyleItalic">Rupture</span>" 1 => "<span class="elsevierStyleItalic">Diaphragm</span>" 2 => "<span class="elsevierStyleItalic">Injury</span>" 3 => "<span class="elsevierStyleItalic">Surgery</span>" 4 => "<span class="elsevierStyleItalic">Outcomes</span>" 5 => "<span class="elsevierStyleItalic">Survival</span>" 6 => "<span class="elsevierStyleItalic">Morbidity</span>" 7 => "<span class="elsevierStyleItalic">Mortality</span>" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec155221" "palabras" => array:8 [ 0 => "<span class="elsevierStyleItalic">Rotura</span>" 1 => "<span class="elsevierStyleItalic">Diafragma</span>" 2 => "<span class="elsevierStyleItalic">Traumatismo</span>" 3 => "<span class="elsevierStyleItalic">Cirugía</span>" 4 => "<span class="elsevierStyleItalic">Resultados</span>" 5 => "<span class="elsevierStyleItalic">Supervivencia</span>" 6 => "<span class="elsevierStyleItalic">Morbilidad</span>" 7 => "<span class="elsevierStyleItalic">Mortalidad</span>" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">Traumatic rupture of the diaphragm (TRD) is a rare occurrence, with variable morbidity and mortality. The aim of this study was to analyze cases of TRD in a tertiary hospital and assess prognostic factors associated with mortality.</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p class="elsevierStyleSimplePara elsevierViewall">A retrospective study was performed of patients diagnosed with TRD in Hospital Universitario La Fe, Valencia, Spain, between 1969 and 2006. The following variables were analyzed: sex, age, cause, diagnosis, associated lesions, surgical procedure, side and size of the lesion, visceral herniation, and postoperative morbidity and mortality.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">The study group comprised 132 patients (105 men, 79.5%) with a mean (SD) age of 39.64 (17.04) years. Traffic accidents were the most common cause of TRD. Rupture involved the left hemidiaphragm in 96 cases (72.7%), and 113 patients (85.6%) had associated lesions, most often affecting the abdomen. Thoracotomy was performed in 83 cases (62.9%) and laparotomy in 41 (31.1%). Visceral herniation was reported in 90 patients (68.3%), most often involving the stomach.</p><p class="elsevierStyleSimplePara elsevierViewall">The rates of perioperative morbidity and mortality were 62.8% and 20.5%, respectively. Diagnostic delay and the presence of morbidity and serious associated lesions all had a statistically significant impact on mortality (<span class="elsevierStyleItalic">P</span><.05). In the case of serious associated lesions, the odds ratio was 2.898 (95% confidence interval, 1.018-8.250) and for perioperative morbidity it was 1.488 (95% confidence interval, 1.231-1.798).</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">TRD is an infrequent occurrence in young men, is generally caused by traffic accidents, and is more common on the left side. Associated lesions are present in most cases and represent the main prognostic factor affecting morbidity and mortality. TRD can be considered a relative surgical emergency when not accompanied by other lesions that in themselves constitute surgical emergencies.</p>" ] "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">La rotura diafragmática traumática (RDT) es una lesión infrecuente, con tasas variables de morbimortalidad. El objetivo del estudio ha sido analizar la experiencia en RDT de un hospital terciario y los factores pronósticos de mortalidad.</p> <span class="elsevierStyleSectionTitle">Pacientes y métodos</span><p class="elsevierStyleSimplePara elsevierViewall">Se ha realizado un estudio analítico y retrospectivo de los pacientes diagnosticados de RDT entre 1969 y 2006 en el Hospital La Fe. Se analizaron: sexo, edad, causa, diagnóstico, lesiones asociadas, procedimiento quirúrgico, lado y tamaño, herniación visceral y morbimortalidad postoperatoria.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Se incluyó en el estudio a 132 pacientes (105 varones; 79,5%) con una edad media ± desviación estándar de 39,64 ± 17,04 años. Los accidentes de tráfico fueron la causa más frecuente de RDT. En 96 casos (72,7%) se afectó el hemidiafragma izquierdo y 113 pacientes (85,6%) asociaron lesiones, de las cuales las abdominales fueron las más frecuentes. Se abordaron por toracotomía 83 casos (62,9%) y por laparotomía 41 (31,1%). En 90 pacientes (68,3%) se evidenció herniación visceral, siendo el estómago la más frecuente.</p><p class="elsevierStyleSimplePara elsevierViewall">Las tasas de morbilidad y mortalidad perioperatorias fueron del 62,8 y el 20,5%, respectivamente. La presencia de morbilidad y de lesiones asociadas graves, y el retraso diagnóstico tuvieron un impacto significativo en la mortalidad (p < 0,05. Lesiones graves: <span class="elsevierStyleItalic">odds ratio</span> = 2,898; intervalo de confianza del 95%, 1,018-8,250. Morbilidad perioperatoria: <span class="elsevierStyleItalic">odds ratio</span> = 1,488; intervalo de confianza del 95%, 1,231-1,798).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">La RDT es una entidad infrecuente que se da en varones jóvenes, generalmente por accidentes de tráfico, y es más frecuente en el lado izquierdo. Las lesiones asociadas están presentes en la mayoría de los casos y son el principal factor pronóstico que condiciona la morbimortalidad. La RDT puede considerarse una urgencia quirúrgica diferida, en ausencia de otras lesiones que constituyan una urgencia quirúrgica en sí mismas.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:24 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Traumatic diaphragmatic hernia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C Schneider" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Surg" "fecha" => "1956" "volumen" => "91" "paginaInicial" => "290" "paginaFinal" => "294" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/13283218" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Traumatic diaphragmatic hernia: occult marker of serious injury" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B Meyers" 1 => "C McCabe" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Surg" "fecha" => "1993" "volumen" => "218" "paginaInicial" => "783" "paginaFinal" => "790" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8257229" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A comparison of right and left blunt traumatic diaphragmatic rupture" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "BR Boulanger" 1 => "DP Milzman" 2 => "C Rosati" 3 => "A Rodríguez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Trauma" "fecha" => "1993" "volumen" => "35" "paginaInicial" => "255" "paginaFinal" => "260" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8355305" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Blunt chest injuries in 1696 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G Galán" 1 => "JC Peñalver" 2 => "F Paris" 3 => "JM Caffarena Jr." 4 => "E Blasco" 5 => "JM Borro" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur J Cardiothorac Surg" "fecha" => "1992" "volumen" => "6" "paginaInicial" => "284" "paginaFinal" => "287" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1616723" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Traumatic rupture of the diaphragm; 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 1 | 3 |
| 2024 October | 37 | 31 | 68 |
| 2024 September | 32 | 17 | 49 |
| 2024 August | 61 | 30 | 91 |
| 2024 July | 32 | 21 | 53 |
| 2024 June | 47 | 24 | 71 |
| 2024 May | 54 | 28 | 82 |
| 2024 April | 33 | 23 | 56 |
| 2024 March | 39 | 19 | 58 |
| 2024 February | 31 | 18 | 49 |
| 2023 March | 3 | 4 | 7 |
| 2023 February | 30 | 19 | 49 |
| 2023 January | 17 | 35 | 52 |
| 2022 December | 16 | 38 | 54 |
| 2022 November | 17 | 17 | 34 |
| 2022 October | 28 | 29 | 57 |
| 2022 September | 18 | 28 | 46 |
| 2022 August | 17 | 32 | 49 |
| 2022 July | 21 | 38 | 59 |
| 2022 June | 16 | 28 | 44 |
| 2022 May | 17 | 33 | 50 |
| 2022 April | 20 | 37 | 57 |
| 2022 March | 16 | 25 | 41 |
| 2022 February | 17 | 27 | 44 |
| 2022 January | 16 | 42 | 58 |
| 2021 December | 21 | 50 | 71 |
| 2021 November | 16 | 46 | 62 |
| 2021 October | 26 | 53 | 79 |
| 2021 September | 18 | 64 | 82 |
| 2021 August | 8 | 43 | 51 |
| 2021 July | 11 | 38 | 49 |
| 2021 June | 15 | 29 | 44 |
| 2021 May | 8 | 28 | 36 |
| 2021 April | 26 | 61 | 87 |
| 2021 March | 18 | 35 | 53 |
| 2021 February | 16 | 21 | 37 |
| 2021 January | 12 | 13 | 25 |
| 2020 December | 9 | 13 | 22 |
| 2020 November | 12 | 14 | 26 |
| 2020 October | 9 | 7 | 16 |
| 2020 September | 6 | 6 | 12 |
| 2020 August | 12 | 11 | 23 |
| 2020 July | 11 | 15 | 26 |
| 2020 June | 4 | 6 | 10 |
| 2020 May | 11 | 23 | 34 |
| 2020 April | 14 | 14 | 28 |
| 2020 March | 12 | 10 | 22 |
| 2020 February | 8 | 11 | 19 |
| 2020 January | 11 | 23 | 34 |
| 2019 December | 10 | 12 | 22 |
| 2019 November | 9 | 11 | 20 |
| 2019 October | 12 | 6 | 18 |
| 2019 September | 11 | 16 | 27 |
| 2019 August | 12 | 8 | 20 |
| 2019 July | 13 | 28 | 41 |
| 2019 June | 6 | 11 | 17 |
| 2019 May | 13 | 22 | 35 |
| 2019 April | 23 | 27 | 50 |
| 2019 March | 9 | 22 | 31 |
| 2019 February | 3 | 8 | 11 |
| 2019 January | 7 | 10 | 17 |
| 2018 December | 8 | 10 | 18 |
| 2018 November | 10 | 14 | 24 |
| 2018 October | 12 | 24 | 36 |
| 2018 September | 11 | 7 | 18 |
| 2018 May | 3 | 0 | 3 |
| 2018 April | 10 | 7 | 17 |
| 2018 March | 3 | 3 | 6 |
| 2018 February | 5 | 8 | 13 |
| 2018 January | 3 | 6 | 9 |
| 2017 December | 5 | 7 | 12 |
| 2017 November | 3 | 7 | 10 |
| 2017 October | 2 | 14 | 16 |
| 2017 September | 4 | 19 | 23 |
| 2017 August | 5 | 16 | 21 |
| 2017 July | 2 | 21 | 23 |
| 2017 June | 11 | 27 | 38 |
| 2017 May | 4 | 17 | 21 |
| 2017 April | 3 | 21 | 24 |
| 2017 March | 2 | 7 | 9 |
| 2017 February | 1 | 9 | 10 |
| 2017 January | 3 | 5 | 8 |
| 2016 December | 6 | 5 | 11 |
| 2016 November | 16 | 13 | 29 |
| 2016 October | 10 | 21 | 31 |
| 2016 September | 5 | 6 | 11 |
| 2016 August | 7 | 5 | 12 |
| 2016 July | 5 | 8 | 13 |
| 2016 March | 2 | 0 | 2 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 49 | 8 | 57 |
| 2015 September | 59 | 9 | 68 |
| 2015 August | 64 | 13 | 77 |
| 2015 July | 70 | 12 | 82 |
| 2015 June | 37 | 4 | 41 |
| 2015 May | 67 | 9 | 76 |
| 2015 April | 47 | 8 | 55 |
| 2015 March | 52 | 8 | 60 |
| 2015 February | 37 | 5 | 42 |
| 2015 January | 39 | 5 | 44 |
| 2014 December | 52 | 5 | 57 |
| 2014 November | 62 | 7 | 69 |
| 2014 October | 75 | 6 | 81 |
| 2014 September | 37 | 7 | 44 |
| 2014 August | 42 | 9 | 51 |
| 2014 July | 42 | 5 | 47 |
| 2014 June | 61 | 10 | 71 |
| 2014 May | 67 | 9 | 76 |
| 2014 April | 56 | 7 | 63 |
| 2014 March | 69 | 17 | 86 |
| 2014 February | 54 | 12 | 66 |
| 2014 January | 34 | 12 | 46 |
| 2013 December | 50 | 10 | 60 |
| 2013 November | 41 | 17 | 58 |
| 2013 October | 53 | 15 | 68 |
| 2013 September | 41 | 5 | 46 |
| 2013 August | 54 | 11 | 65 |
| 2013 July | 57 | 8 | 65 |
| 2013 June | 38 | 9 | 47 |
| 2013 May | 47 | 6 | 53 |
| 2013 April | 29 | 6 | 35 |
| 2013 March | 9 | 2 | 11 |
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