Kafih M, Boufettal R
Service des urgences viscérales chirurgicales, CHU Ibn Rochd, Casablanca, Morocco.
Rev Pneumol Clin. 2009 Feb;65(1):23-6. doi: 10.1016/j.pneumo.2008.10.004. Epub 2009 Jan 8.
Post-traumatic diaphragmatic hernia is a particular lesion in traumatology that may be neglected. Thus, the diagnosis may be delayed for a few days to several months and only be made following a complication. The left diaphragmatic cupola is the most touched. Tension fecopneumothorax following diaphragmatic hernia perforation in the pleural cavity is a rare but particularly severe complication of traumatic diaphragmatic hernia.
A 68-year-old man was admitted for acute intestinal occlusion with respiratory distress. A history of a violent blunt thoraco-abdominal traumatism resulting from a traffic accident eight years before was noted. The chest x-ray revealed an abundant hydropneumothorax and the thoracic scan revealed abundant effusion with heterogeneous density in the left pleural cavity, associated with an intrapleural hernia of the large intestine. An emergency thoracolaparotomy discovered tension fecopneumothorax secondary to intrathoracic perforation of the transverse colon through a left hemidiaphragm defect. The surgical treatment consisted of hernia reduction, pleural drainage, colostomy and repair of the diaphragmatic defect.
The possibility of diaphragmatic hernia should be kept in mind in case of violent blunt thoraco-abdominal traumatism or basithoracic wound. In this way, complications such as tension fecopneumothorax that could threaten the functional and vital prognosis may be prevented.
创伤性膈疝是创伤学中一种可能被忽视的特殊损伤。因此，诊断可能会延迟数天至数月，且往往是在出现并发症后才得以确诊。左侧膈穹隆是最常受累的部位。创伤性膈疝破入胸腔后形成的张力性粪气胸是一种罕见但特别严重的并发症。
一名68岁男性因急性肠梗阻伴呼吸窘迫入院。有记录显示，其在八年前曾因交通事故遭受暴力钝性胸腹外伤。胸部X光显示大量液气胸，胸部扫描显示左侧胸腔有大量密度不均匀的积液，伴有大肠胸腔内疝。急诊胸腹联合切开术发现，横结肠经左半膈肌缺损处胸腔内穿孔导致张力性粪气胸。手术治疗包括疝还纳、胸腔引流、结肠造口术及膈肌缺损修复。
对于暴力钝性胸腹外伤或下胸部伤口，应考虑到膈疝的可能性。这样，就可以预防可能威胁功能和生命预后的张力性粪气胸等并发症。
