Muroni Mirko, Provenza Giuseppe, Conte Stefano, Sagnotta Andrea, Petrucciani Niccolò, Gentili Ivan, Di Cesare Tatiana, Kazemi Andrea, Masoni Luigi, Ziparo Vincenzo
Department of General Surgery, La Sapienza University of Rome, Second School of Medicine, St, Andrea Hospital, via di Grottarossa 1035, 00189 Rome, Italy.
J Med Case Rep. 2010 Aug 24;4:289. doi: 10.1186/1752-1947-4-289.
Traumatic diaphragmatic hernias are an unusual presentation of trauma, and are observed in about 10% of diaphragmatic injuries. The diagnosis is often missed because of non-specific clinical signs, and the absence of additional intra-abdominal and thoracic injuries.
We report a case of a 59-year-old Italian man hospitalized for abdominal pain and vomiting. His medical history included a blunt trauma seven years previously. A chest X-ray showed right diaphragm elevation, and computed tomography revealed that the greater omentum, a portion of the colon and the small intestine had been transposed in the hemithorax through a diaphragm rupture. The patient underwent laparotomy, at which time the colon and small intestine were reduced back into the abdomen and the diaphragm was repaired.
This was a unusual case of traumatic right-sided diaphragmatic hernia. Diaphragmatic ruptures may be revealed many years after the initial trauma. The suspicion of diaphragmatic rupture in a patient with multiple traumas contributes to early diagnosis. Surgical repair remains the only curative treatment for diaphragmatic hernias. Prosthetic patches may be a good solution when the diaphragmatic defect is severe and too large for primary closure, whereas primary repair remains the gold standard for the closure of small to moderate sized diaphragmatic defects.
创伤性膈疝是一种不常见的创伤表现，约占膈肌损伤的10%。由于临床体征不具特异性，且无其他腹内和胸部损伤，诊断常常被漏诊。
我们报告一例59岁意大利男性因腹痛和呕吐入院。他的病史包括7年前的钝性创伤。胸部X线显示右侧膈肌抬高，计算机断层扫描显示大网膜、部分结肠和小肠通过膈肌破裂进入半侧胸腔。患者接受了剖腹手术，术中将结肠和小肠回纳至腹腔并修复膈肌。
这是一例罕见的创伤性右侧膈疝病例。膈肌破裂可能在初始创伤多年后才被发现。对多发伤患者怀疑有膈肌破裂有助于早期诊断。手术修复仍然是膈疝唯一的治愈性治疗方法。当膈肌缺损严重且过大无法一期缝合时，人工补片可能是一个好的解决方案，而一期修复仍然是闭合中小尺寸膈肌缺损的金标准。
