Yoshizu Akira, Kamiya Kazunori
Department of General Thoracic Surgery, Yokohama Municipal Citizen's Hospital, Yokohama, Japan.
Kyobu Geka. 2011 Jun;64(6):487-90.
Diaphragmatic hernia complicating pregnancy is rare and results in a high mortality rate, if early surgical intervention is not undertaken. We report a case of a woman at 32 week's gestation who was admitted to our hospital due to severe epigastralgia. Diaphragmatic relaxation had been pointed out since her birth. The patient was initially diagnosed with acute gastritis, but she developed acute respiratory insufficiency on day 3 of hospitalization. Chest X-ray and computed tomography showed niveau in the left pleural cavity. She was treated with chest tube drainage and an emergency caesarean was performed. The next day, gastric fiberscope demonstrated perforation of gastric ulcer in the left hemithorax. She was diagnosed as having diaphragmatic hernia complicated by a perforated stomach. Emergency thoracotomy was carried out and primary repair of both stomach and diaphragma was performed.
妊娠合并膈疝较为罕见,若不早期进行手术干预,死亡率很高。我们报告一例妊娠32周的女性患者,因严重上腹部疼痛入院。自出生起就发现有膈肌松弛。患者最初被诊断为急性胃炎,但住院第3天出现急性呼吸功能不全。胸部X线和计算机断层扫描显示左侧胸腔有液平面。对其进行了胸腔闭式引流治疗,并实施了急诊剖宫产。次日,胃镜检查显示左半胸有胃溃疡穿孔。她被诊断为膈疝合并胃穿孔。进行了急诊开胸手术,对胃和膈肌进行了一期修复。