Abboud Bassam, Jaoude Joe Bou, Riachi Moussa, Sleilaty Ghassan, Tabet Georges
Department of General Surgery, Hôtel-Dieu de France Hospital, Alfred Naccache Street, Beirut, Lebanon.
J Med Liban. 2004 Jul-Sep;52(3):168-70.
Herniation of abdominal contents through the diaphragm has been described for a variety of diaphragmatic defects and may be secondary to diaphragmatic injury, either traumatic or iatrogenic. The sequelae of diaphragmatic hernia include intestinal obstruction, strangulation, gangrene and, eventually, perforation. The aim of this study was to report a case of intrathoracic infarction of transverse colon and two meters of small bowel in a patient with traumatic diaphragmatic hernia.
Young man with past history of blunt abdominal trauma presented abdominal pain with dyspnea. An exploratory laparotomy was performed. The esophageal hiatus was normal but a 4.5 cm rent was discovered in the posterior leaf of the left hemidiaphragm. Passing through the defect was the transverse colon and a proximal small bowel. The herniated transverse colon and jejunum were massively dilated with evidence of infarction. Transverse colectomy and resection of two meters of jejunum with direct anastomosis were performed. Following bowel removal, diaphragm was directly repaired without graft. Finally, a chest tube was placed in the left hemithorax.
Postoperative course was uneventful and he recovered without complications. He was discharged from hospital 10 days after surgery.
Surgeons, internists and emergency medicine personnel should be aware of the possibility of diaphragmatic hernia in patients with a known history of abdominal trauma. Though uncommon, strangulation of colon and small bowel through a rent in diaphragm should be considered when there is radiologic evidence of herniation.
腹内容物通过膈肌突出可因多种膈肌缺损引起，可能继发于创伤性或医源性膈肌损伤。膈肌疝的后遗症包括肠梗阻、绞窄、坏疽，最终穿孔。本研究的目的是报告一例创伤性膈肌疝患者横结肠及两米小肠发生胸腔内梗死的病例。
一名有腹部钝性创伤史的年轻男性，出现腹痛伴呼吸困难。进行了剖腹探查术。食管裂孔正常，但在左半膈肌后叶发现一个4.5厘米的裂口。横结肠和一段近端小肠通过该缺损处。疝出的横结肠和空肠大量扩张，有梗死迹象。行横结肠切除术及两米空肠切除并直接吻合。切除肠管后，直接修复膈肌，未使用移植物。最后，在左胸腔置入胸腔引流管。
术后病程顺利，患者康复，无并发症。术后10天出院。
外科医生、内科医生和急诊医学人员应意识到有腹部创伤史患者发生膈肌疝的可能性。虽然罕见，但当有影像学证据显示疝出时，应考虑结肠和小肠通过膈肌裂口发生绞窄的情况。
