Montresor E, Procacci C, Guarise A, Minniti S, Bortolasi L, Nifosì F, Marinello P, Mainente M, Puchetti V
Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Università degli Studi di Verona.
Chir Ital. 1999 Nov-Dec;51(6):471-6.
The herniation of abdominal viscera in the thorax can immediately follow diaphragmatic rupture or be delayed even years after the injury. The herniated viscera can strangulate; this consequence may lead to a dangerous misdiagnosis which could be lethal for the patient. Radiological procedures, serial chest X-ray studies, CT and MRI scans are mandatory to confirm diagnosis. The insertion of a naso-gastric tube is a very helpful method in ruling out hypertensive pneumothorax in the presence of an air-fluid level in the thorax. We report 2 cases of strangulated traumatic hernia of the diaphragm occurring just a few hours (case 1) and 18 months (case 2) after the trauma. During thoracotomy, a rupture of the left diaphragmatic cupola was demonstrated with herniation of the stomach in case 1, the stomach, spleen and transverse colon in case 2. No postoperative mortality or morbidity were detected.
腹腔脏器疝入胸腔可在膈肌破裂后立即发生，也可能在损伤后数年才出现延迟。疝入的脏器可能会发生绞窄；这种情况可能导致危险的误诊，对患者来说可能是致命的。放射学检查，包括系列胸部X线检查、CT和MRI扫描对于确诊是必不可少的。在胸腔存在气液平面时，插入鼻胃管是排除高血压性气胸的一种非常有用的方法。我们报告2例创伤后数小时（病例1）和18个月（病例2）发生的绞窄性创伤性膈肌疝。在开胸手术中，病例1显示左膈穹窿破裂，胃疝入；病例2显示胃、脾和横结肠疝入。未发现术后死亡或并发症。
