Ting Joseph Yuk Sang
Department of Emergency Medicine, Mater Public Hospitals, South Brisbane, Queensland, Australia.
Emerg Med Australas. 2008 Oct;20(5):441-3. doi: 10.1111/j.1742-6723.2008.01119.x.
Hyperemesis gravidarum is a frequent presentation to the ED, which usually resolves with fluid rehydration and antiemetics. Early incarcerated maternal diaphragmatic hernia might be misdiagnosed as relatively benign hyperemesis gravidarum in the first two trimesters of pregnancy. Diagnosis is missed because of non-specific presentation with abdominal pain, nausea and vomiting. Hernias rarely become symptomatic even in latter stages of pregnancy, as the uterus increases in size with each trimester and with raised intra-abdominal pressure from uterine contraction during labour. Symptoms progress with incarceration and strangulation of abdominal contents within the thoracic cavity, compression of the lung and disruption of caval venous return. A woman at 19-week gestation presented with delayed diagnosis of strangulated diaphragmatic hernia, representing the earliest gestation in the published literature when this has occurred. She had repeatedly been misdiagnosed with hyperemesis gravidarum. It is worthwhile considering incarcerated maternal diaphragmatic hernia as an unusual cause of refractory vomiting in pregnancy, when associated with clinically significant upper abdominal pain and progressive respiratory embarrassment. This might occur as early as the mid-second trimester, and without uterine contraction.
妊娠剧吐是急诊科的常见病症，通常通过补液和使用止吐药得以缓解。早期嵌顿性母体膈疝在妊娠的前两个月可能会被误诊为相对良性的妊娠剧吐。由于出现腹痛、恶心和呕吐等非特异性症状，导致诊断失误。即使在妊娠后期，疝也很少出现症状，因为随着孕期进展子宫不断增大，且分娩时子宫收缩会使腹内压升高。随着胸腔内腹腔内容物发生嵌顿和绞窄、肺部受压以及腔静脉回流受阻，症状会逐渐加重。一名妊娠19周的女性出现绞窄性膈疝的延迟诊断，这是已发表文献中出现这种情况的最早孕周。她曾多次被误诊为妊娠剧吐。当妊娠合并严重上腹部疼痛和进行性呼吸窘迫导致难治性呕吐时，应考虑嵌顿性母体膈疝这一不常见病因。这种情况可能早在妊娠中期就会出现，且无子宫收缩。
