Kumar Shailesh, Kumar Santosh, Bhaduri Shubhendu, More Sumit, Dikshit Priyadarshi
Department of Gen Surgery, PGIMER & Dr. RML Hospital, New Delhi, India.
Int J Surg Case Rep. 2013;4(5):446-8. doi: 10.1016/j.ijscr.2013.02.006. Epub 2013 Feb 24.
Post traumatic diaphragmatic hernia is very often missed particularly in polytrauma patients. We present case of an isolated post traumatic diaphragmatic hernia with strangulation, a very rare finding.
A 35 year old man presented with features of intestinal obstruction with past history of a seemingly trivial blunt thoracic injury 15 years back. Findings of X-ray abdomen and chest with high leukocyte count raised suspicion of obstructed diaphragmatic hernia which on exploration revealed obstructed diaphragmatic hernia with gangrenous bowel segment.
Blunt injury of diaphragm is relatively common and is considered as a marker of severe trauma and it can clinically be occult as other violent injuries may mask and disguise its initial clinical presentation(1) resulting in late presentation with obstruction and/or rarely strangulation. An early diagnosis of the condition is prudent to avoid morbidity and mortality associated with late presentations.
In a patient of intestinal obstruction with history of even trivial throraco- abdominal injury, diagnosis of diaphragmatic hernia should be kept in mind.
创伤后膈疝常常被漏诊，尤其是在多发伤患者中。我们报告一例孤立性创伤后绞窄性膈疝病例，这是一种非常罕见的情况。
一名35岁男性因肠梗阻症状就诊，有15年前看似轻微的钝性胸部损伤史。腹部和胸部X线检查结果及白细胞计数升高提示为梗阻性膈疝，手术探查发现为梗阻性膈疝伴肠段坏疽。
膈肌钝性损伤相对常见，被视为严重创伤的标志，临床上可能隐匿，因为其他严重损伤可能掩盖其最初的临床表现(1)，导致出现梗阻和/或罕见的绞窄时才被发现。早期诊断该疾病对于避免与延迟就诊相关的发病率和死亡率至关重要。
对于有哪怕是轻微胸腹损伤史的肠梗阻患者，应考虑膈疝的诊断。
