Shah Neha, Fernandes Roland, Thakrar Amit, Rozati Hamoun
William Harvey Hospital, London, UK.
BMJ Case Rep. 2013 Apr 23;2013:bcr2013008699. doi: 10.1136/bcr-2013-008699.
A 53-year-old lady presented to A&E with a 3-day history of severe epigastric pain and vomiting. This was preceded by a 3-month history of generalised abdominal discomfort, early satiety and increasing shortness of breath. A CT scan showed a left-sided posterior diaphragmatic defect. Urgent repair of the hernia showed herniation of three-quarter of the stomach, half of the transverse colon, the 13 cm spleen and the pancreas in the chest. There were no postoperative complications. Traumatic diaphragmatic hernias are known to be a complication of major trauma. However, the patient in this case report presented acutely, after mild physical trauma related to using a rowing machine. This exercise, when not performed correctly can raise intra-abdominal pressure. It is plausible that this trauma, although mild, was sufficient in causing the lady's diaphragmatic hernia. This case would suggest that the trauma required to cause a diaphragmatic hernia need not be as severe as originally thought.
一位53岁女性因严重上腹痛和呕吐3天就诊于急诊。在此之前，她有3个月的腹部不适、早饱及呼吸急促加重的病史。CT扫描显示左侧膈肌后部缺损。急诊疝修补术显示四分之三的胃、一半的横结肠、13厘米的脾脏和胰腺疝入胸腔。术后无并发症。创伤性膈肌疝是重大创伤的一种并发症。然而，本病例报告中的患者在与使用划船机相关的轻度身体创伤后急性发病。这项运动如果操作不当会升高腹内压。虽然此次创伤轻微，但很可能足以导致该女性发生膈肌疝。该病例表明，导致膈肌疝所需的创伤不一定像最初认为的那么严重。
