Kamiyoshihara Mitsuhiro, Nagashima Toshiteru, Ibe Takashi, Takeyoshi Izumi
Department of General Thoracic Surgery, Maebashi Red Cross Hospital, Maebashi, Gunma, Japan.
Gen Thorac Cardiovasc Surg. 2010 Jun;58(6):291-4. doi: 10.1007/s11748-009-0520-3. Epub 2010 Jun 13.
A 61-year-old man was transferred to our institution because of blunt chest trauma after accidentally falling. A chest roentgenogram (CXR) and computed tomography (CT) revealed bilateral hemopneumothorax and fractures of multiple left ribs, the pelvis, and the left femur. On the second day in hospital, the patient suddenly complained of dyspnea. Emergency CXR and CT revealed elevation of the left diaphragm, suggestive of a traumatic diaphragmatic hernia; emergency surgery was performed. We confirmed rupture of the diaphragm and pericardium with cardiac herniation: the pleural pericardium and diaphragm were torn individually, and the heart and abdominal organs had herniated into the pleural cavity. They were repaired, and there were no cardiopulmonary complications during or after the operation. Pericardiodiaphragmatic rupture with cardiac herniation after multiple blunt traumas is rare. We describe the successful treatment of a diaphragmatic and pericardial rupture with cardiac herniation, with special reference to pericardial injuries.
一名61岁男性因意外摔倒导致钝性胸部创伤被转至我院。胸部X线片（CXR）和计算机断层扫描（CT）显示双侧血气胸以及左侧多根肋骨、骨盆和左股骨骨折。住院第二天，患者突然出现呼吸困难。急诊CXR和CT显示左侧膈肌抬高，提示创伤性膈疝；遂进行急诊手术。我们证实膈肌和心包破裂伴心脏疝出：胸膜心包和膈肌分别撕裂，心脏和腹部器官疝入胸腔。对其进行了修复，手术期间及术后均未出现心肺并发症。多处钝性创伤后发生心包膈破裂伴心脏疝出较为罕见。我们描述了一例膈肌和心包破裂伴心脏疝出的成功治疗病例，并特别提及心包损伤。
