Rifki Jai Saâd, Bensardi Fatimazahra, Hizaz Ahmed, Chehab Farid, Khaiz Driss, Bouzidi Abdelmajid
Department of Surgery III, Ibn Rochd University Hospital, Casablanca, Morocco.
Arch Gynecol Obstet. 2007 Sep;276(3):295-8. doi: 10.1007/s00404-007-0347-z. Epub 2007 Apr 4.
Diaphragmatic hernia during pregnancy is uncommon and is usually traumatic in origin, epigastric pain, and vomiting could be the initial symptoms of herniation of gastrointestinal contents, with a risk of strangulation and ischaemia, leading to respiratory distress due to collapse of the lung.
Case report.
A 27-year-old woman, with undiagnosed traumatic diaphragmatic hernia who presented, at 32 weeks' gestation, epigastric pain, vomiting and tachycardia, immediate post-partum course was complicated by respiratory failure. A chest X-ray showed an air fluid level in the left lung which was wrongly diagnosed as an hydropneumothorax, in front of respiratory symptoms exacerbation, an inappropriate thoracic drainage tube was accidentally placed into the herniated stomach leading to perforation of this last. An emergency laparotomy discovered a 2/3 of the stomach, transverse colon and greater omentum herniated in the left hemithorax through a defect of the left hemidiaphragm.
The diagnosis should then be considered early, and chest radiography with a nasogastric tube is the first technique to prefer and may be helpful to confirm the diagnosis.
妊娠期膈疝并不常见，通常由外伤引起，上腹部疼痛和呕吐可能是胃肠道内容物疝出的初始症状，存在绞窄和缺血风险，可导致肺部塌陷引起呼吸窘迫。
病例报告。
一名27岁女性，患有未确诊的创伤性膈疝，在妊娠32周时出现上腹部疼痛、呕吐和心动过速，产后立即出现呼吸衰竭并发症。胸部X线显示左肺有气液平面，被误诊为液气胸，在呼吸症状加重之前，一根不合适的胸腔引流管意外插入疝出的胃中，导致胃穿孔。急诊剖腹手术发现胃的2/3、横结肠和大网膜通过左半膈肌缺损疝入左胸腔。
应尽早考虑诊断，鼻胃管胸部X线检查是首选的首要技术，可能有助于确诊。
