title: Laparoscopy for Occult Left-sided Diaphragm Injury Following Penetrating Thoracoabdominal Trauma is Both Diagnostic and Therapeutic.
abstract: BACKGROUND
  The diagnosis of occult traumatic diaphragm injury (TDI) has posed a dilemma to trauma surgeons. No imaging modality can accurately and conclusively identify small defects in the integrity of the diaphragm following penetrating trauma. Diagnostic laparoscopy (DL) offers a minimally invasive method of evaluating the integrity of the diaphragm.
  
  
  METHODS
  An Electronic Surgical Registry (ESR) and a Hybrid Electronic Medical Record (HEMR) system have been maintained within the Pietermaritzburg Metropolitan Trauma Service since January 1, 2012. The study was conducted between 2 hospitals located in Pietermaritzburg, KwaZulu Natal, South Africa, namely, Greys (tertiary) and Edendale (regional). Patient data were entered into the registries at the end of patient care (discharge, interhospital transfer, or death). The registries were interrogated to retrieve all cases of DL performed for left-sided penetrating thoracoabdominal trauma.
  
  
  RESULTS
  A total of 96 patients underwent semielective DL following penetrating left-sided thoracoabdominal trauma. This included 94 stab wounds and 2 gunshot wounds. The mean patient age was 29 years (range, 15 to 68 y, SD=8.8). The majority (59/96) of patients were male. Twenty-two (23% incidence) cases of TDI were identified at DL. Eighteen (82%) were repaired laparoscopically, and the remaining 4 required conversion to laparotomy and open repair.
  
  
  CONCLUSIONS
  TDI presents in a spectrum from the obvious to the occult. Our results validate the utilization of DL as a minimally invasive intervention for both the diagnosis and repair of TDI in selected patients presenting with penetrating left-sided thoracoabdominal trauma.
authors.affiliation: *Department of General Surgery, Salisbury District Hospital, Wiltshire, UK †Pietermaritzburg Metropolitan Department of Surgery, Pietermaritzburg Metropolitan Trauma Service, Nelson R. Mandela School of Medicine, University of KwaZulu Natal, Pietermaritzburg, KwaZulu-Natal, South Africa.
authors.forename: Nigel
authors.initials: N
authors.lastname: D'Souza
authors.forename: John L
authors.initials: JL
authors.lastname: Bruce
authors.forename: Damian L
authors.initials: DL
authors.lastname: Clarke
authors.forename: Grant L
authors.initials: GL
authors.lastname: Laing
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D003964:Diaphragm / Q000293:injuries*; D005260:Female; D006801:Humans; D033162:Incidental Findings; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013898:Thoracic Injuries / Q000175:diagnosis / Q000601:surgery; D014948:Wounds, Gunshot / Q000175:diagnosis / Q000601:surgery*; D014951:Wounds, Stab / Q000175:diagnosis / Q000601:surgery*; D055815:Young Adult