Beigi Ali Akbar, Masoudpour Hassan, Sehhat Siavoush, Khademi Elham Fatemeh
Department of Vascular Surgery, Isfahan University of Medical Sciences, Alzahra Hospital, Isfahan, Iran.
Ulus Travma Acil Cerrahi Derg. 2010 May;16(3):215-9.
Traumatic diaphragmatic hernias commonly occur after blunt and penetrating trauma. The difficulties in diagnosing traumatic diaphragmatic rupture due to coexisting injuries and the silent nature of the diaphragmatic injuries at the first admission are the most common causes of delayed diagnosis.
The medical records of 34 patients (28 male, 6 female; mean age 32.3 years; range 1 to 68) treated for post-traumatic diaphragmatic hernias between August 2004 and June 2008 in Alzahra Hospital were analyzed retrospectively.
Rupture of the diaphragm was left-sided in 22 (64.7%) and right-sided in 11 (32.4%) and bilateral in 1 (2.9%) of the patients. Blunt trauma accounted for the injuries of 22 patients (64.7%). In the first operation, diagnosis was established preoperatively in 15 patients (44.1%) and intraoperatively in 13 (38.2%). The diagnosis was missed in 6 (17.7%) patients in the first operation. Strangulation of the viscera was seen in three patients. The longest interval between the onset of trauma and diagnosis was approximately three years in one case. Multiple associated injuries were observed in 22 patients (64.7%), the most common of which were spleen injury (38.2%), fractures of the extremities and hemothorax (29.4%) and liver injury (26.5%). Postoperative complications were seen in nine patients (26.5%). Mortality of isolated blunt traumatic rupture was 0%. Hemorrhagic shock, young age and associated injuries significantly increased the mortality and morbidity.
Despite the fact that the incidence of diaphragmatic hernia is uncommon, it should be suspected in all blunt or penetrating traumas of the thorax and abdomen. Because late complications are usually associated with high morbidity, the presence of such an injury should be excluded before terminating the exploratory procedure.
创伤性膈疝常见于钝性和穿透性创伤后。由于合并伤导致创伤性膈肌破裂诊断困难，且首次入院时膈肌损伤无明显症状，是延迟诊断的最常见原因。
回顾性分析2004年8月至2008年6月在阿尔扎赫拉医院接受创伤性膈疝治疗的34例患者（男28例，女6例；平均年龄32.3岁；范围1至68岁）的病历。
22例（64.7%）患者为左侧膈肌破裂，11例（32.4%）为右侧膈肌破裂，1例（2.9%）为双侧膈肌破裂。22例（64.7%）患者的损伤由钝性创伤所致。在首次手术中，15例（44.1%）患者术前确诊，13例（38.2%）患者术中确诊。6例（17.7%）患者在首次手术中漏诊。3例患者出现脏器绞窄。1例患者创伤发作至诊断的最长间隔约为3年。22例（64.7%）患者观察到多发合并伤，最常见的是脾损伤（38.2%）、四肢骨折和血胸（29.4%）以及肝损伤（26.5%）。9例（26.5%）患者出现术后并发症。单纯钝性创伤性破裂的死亡率为0%。失血性休克、年轻及合并伤显著增加死亡率和发病率。
尽管膈疝的发病率不高，但在所有胸腹部钝性或穿透性创伤中均应怀疑有膈疝。由于晚期并发症通常伴有高发病率，在结束探查手术前应排除此类损伤的存在。
