Snyder H S, Salo D F, Kelly P H
Department of Emergency Medicine, Albany Medical Center Hospital, New York 12208.
Ann Emerg Med. 1990 May;19(5):562-4. doi: 10.1016/s0196-0644(05)82190-0.
Delayed herniation of abdominal contents through a congenital diaphragmatic hernia may occur beyond the neonatal period. The case of a 29-month-old child with a Bochdalek hernia presenting as acute respiratory failure is presented. Chest radiography showed a tension gastrothorax that was misread as a tension pneumothorax. Tube thoracostomy resulted in clinical improvement by perforating and decompressing the stomach. Nasogastric tube placement confirmed herniation of the stomach into the left chest and is the initial treatment of choice when a tension gastrothorax is identified. A congenital diaphragmatic hernia must be recognized promptly so that rapid gastric decompression and surgical repair of the diaphragmatic defect can be performed.
腹腔内容物通过先天性膈疝出现延迟性疝出可能发生在新生儿期之后。本文报道了一例29个月大患有Bochdalek疝的儿童，表现为急性呼吸衰竭。胸部X线检查显示为张力性胃胸，被误诊为张力性气胸。胸腔闭式引流术通过穿刺胃并使其减压，从而使临床症状得到改善。鼻胃管置入证实胃疝入左胸，当发现张力性胃胸时，这是首选的初始治疗方法。必须及时识别先天性膈疝，以便能够迅速进行胃减压和膈肌缺损的手术修复。
