Nwafor I A, Eze J C, Aminu M B
National Cardiothoracic Centre for Excellence, University of Nigeria Teaching Hospital, Ituku-Ozala, Enugu.
Niger J Med. 2011 Oct-Dec;20(4):492-3.
Traumatic diaphragmatic rupture through the central tendon with herniation of the stomach and coils of small bowel into the pericardial cavity.
Case note of a patient managed for traumatic diaphragmatic rupture through the central tendon with herniation of the stomach and coils of small bowel into the pericardial cavity was used with a review of relevant literature.
A 49-year old civil engineer who presented with 2-year history of easy fatigability and palpitations as well as a 6-month history of hypertension and was initially managed as a case dilated cardiomyopathy to rule out incipient CCF secondary to hypertension, was evaluated and found to have chronic diaphragmatic hernia through the central tendon with evisceration of the stomach and coils of the small bowel into the pericardial cavity. Though there was history of motor vehicle crash preceding the development of the symptoms, but the long history of effort dyspnoea and palpitations added to enlarged cardiac silhouette on posterior anterior chest x-ray, a diagnostic challenge was posed which was resolved by thoracoabdominal CT scan. Patient had left sided posteriorlateral thoracotomy via 7h intercostal space followed with reduction of thq stomach and coils of small bowel after careful adhesiolysis and repair of the defect in double layers.
High index of suspicion is very important in the diagnosis of diaphragmatic central tendon injury considering the rarity of the injury and diagnostic challenges it poses in chronic form. However, where the facilities are available, CT scan and 2-D echo will most of the time clinch the diagnosis; also is upper gastrointestinal series.
创伤性膈肌中央腱破裂，胃和小肠袢疝入心包腔。
使用一名因创伤性膈肌中央腱破裂、胃和小肠袢疝入心包腔而接受治疗的患者的病例记录，并复习相关文献。
一名49岁的土木工程师，有2年易疲劳和心悸病史，以及6个月高血压病史，最初被作为扩张型心肌病病例进行治疗，以排除高血压继发的早期充血性心力衰竭。经评估发现患有慢性膈肌中央腱疝，胃和小肠袢疝入心包腔。尽管在症状出现之前有机动车碰撞史，但长期的劳力性呼吸困难和心悸病史，加上后前位胸部X线片上心脏轮廓增大，构成了诊断挑战，而胸腹CT扫描解决了这一问题。患者通过第7肋间行左侧后外侧开胸术，在仔细松解粘连并双层修复缺损后，将胃和小肠袢回纳。
考虑到膈肌中央腱损伤的罕见性及其在慢性形式下带来的诊断挑战，高度怀疑指数在诊断中非常重要。然而，在有可用设备的情况下，CT扫描和二维超声大多时候能确诊；上消化道造影也是如此。
