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OBJECTIVE: Recent experience at King Fahad Hospital of the University, Al-Khobar University, Kingdom of Saudi Arabia was reviewed to identify the pitfalls in the diagnosis of diaphragmatic injuries, and attempt to develop a scheme by which early diagnosis is achieved in order to avoid the sequelae of delayed presentations. METHODS: A retrospective chart review of patients admitted to the surgical service, with the diagnosis of diaphragmatic injury was undertaken during the period June 1994 through to June 1999. RESULTS: The total number was 8 patients, and the age ranged between 6-71 years. Of these patients 5 were diagnosed immediately post-traumatic, 2 with delayed presentation, and one with recurrent post-traumatic repair. This case was excluded. Six patients presented following blunt and one after penetrating trauma. Rupture occurred mainly on the left dome of the diaphragm in 5 patients and on the right in 2. Complications ranged from mild chest symptoms to severe respiratory and multi-system involvement. CONCLUSION: Diaphragmatic injuries occurred in 2%-5% of multiple trauma victims. It is considered a predictor of serious associated injuries, However, as many as 10%-30% are missed during the initial evaluation. A high index of suspicion is required, and judicious use of diagnostic aids should be employed to reach early diagnosis to avoid the sequelae of missed injuries.

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BACKGROUND: Intravenous (IV) fluids and nasogastric (MG) intubation can be discarded safely in some abdominal operations, but this practice seems rare in our community. SETTING: A University teaching hospital in Eastern Saudi Arabia. AIMS: To determine the feasibility of the practice in our setting and increase clinicians' awareness of it and encourage its general adoption. METHOD: A prospective verification study in consecutive ASA Classes I and II adult patients scheduled for four commonly performed operations. END POINTS: The practice was considered successful if the patient accepted early oral fluids and did not require re-insertion of IV line. RESULTS: The operations studied were appendicectomy (44), laparoscopic cholecystectomy (35), herniorrhaphy (19) and diagnostic laparoscopy (2). The patients' mean age was 34.1 years (range 14 to 68); 60% were males. The overall success rate was 98%. Thus postoperative IV fluids proved to be unnecessary in these patients; cost savings were achieved and treating teams were freed to focus on other patients who truly required IV fluids. CONCLUSIONS: In our setting also, routine IV fluids are unnecessary and can be discarded safely after appendecectomy, cholecystectomy and herniorrhaphy in adults.

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Full text is available as a scanned copy of the original print version.

RESUMEN

Full text is available as a scanned copy of the original print version.