Boufettal R, Lefriyekh M R, Boufettal H, Fadil A, Zerouali N O
Service des urgences chirurgicales viscérales, CHU Ibn-Rochd, Casablanca, Morocco.
J Gynecol Obstet Biol Reprod (Paris). 2008 Feb;37(1):93-6. doi: 10.1016/j.jgyn.2007.10.001.
We report a case of spontaneous diaphragm rupture during delivery in a 42-year-old woman. The patient presented at surgical emergency department with abdominal pains, vomiting and dyspnea, three days after full-term delivery. The X-ray of the chest and computed tomography showed symptoms of a left diaphragmatic rupture. Laparotomy confirmed the diaphragmatic rupture with herniation of portion of the stomach in the left pleural cavity. Spontaneous diaphragmatic rupture during delivery is uncommon and would result from a sudden sharp rise in the intra-abdominal pressure during the second stage of labor, exacerbated by application of external pressure to the uterine fundus or the upper abdomen. Diaphragmatic rupture during labor is a serious but rare complication that requires emergency surgery to prevent visceral perforation and cardiorespiratory failure. To prevent this complication, the delivery conditions should be improved.
我们报告一例42岁女性在分娩过程中发生自发性膈肌破裂的病例。该患者在足月分娩三天后因腹痛、呕吐和呼吸困难就诊于外科急诊科。胸部X线和计算机断层扫描显示左侧膈肌破裂的症状。剖腹手术证实膈肌破裂，部分胃疝入左胸腔。分娩期间的自发性膈肌破裂并不常见，是由于第二产程中腹内压突然急剧升高，再加上对子宫底或上腹部施加外部压力而加剧。分娩时的膈肌破裂是一种严重但罕见的并发症，需要紧急手术以防止内脏穿孔和心肺功能衰竭。为预防这一并发症，应改善分娩条件。
