Mansour K A, Clements J L, Hatcher C R, Waters D A
Am Surg. 1975 Feb;41(2):97-102.
Traumatic diaphragmatic hernia often is not recognized after the initial injury. Early recognition of this entity is of utmost importance since obstruction, strangulation, hemorrhage, viscus perforation, pleural fistula and empyema may occur at any time following the diaphragmatic disruption. A high index of suspicion, history of previous thoracoabdominal trauma, physical examination of the chest and roentgenographic evidence should aid in early and definitive diagnosis. Right-sided herniation should be considered in the differential diagnosis of masses about the right lower lung or diaphragm. Bilateral ruptures may also be encountered. Operation should be performed as soon as the diagnosis is made. In general, transabdominal route should be used in acute ruptures while chronic herniation should be approached through the chest.
创伤性膈疝在初次受伤后常不易被识别。尽早识别这一病症至关重要，因为在膈肌破裂后的任何时候都可能发生梗阻、绞窄、出血、脏器穿孔、胸膜瘘和脓胸。高度的怀疑指数、既往胸腹外伤史、胸部体格检查及影像学证据有助于早期明确诊断。右下肺或膈肌周围肿块的鉴别诊断应考虑右侧疝。也可能会遇到双侧破裂。一旦确诊应立即手术。一般来说，急性破裂应采用经腹途径，而慢性疝应经胸处理。
