Ganie Farooq Ahmad, Lone Hafeezulla, Lone Ghulam Nabi, Wani Mohd Lateef, Ganie Shabir Ahmad, Wani Nasir-U-Din, Gani Masaratul
Department of Cardiovascular and Thoracic Surgery, SKIMS Soura, Srinagar, India.
Department of General Surgery, Kidney Hospital, Srinagar, India.
Trauma Mon. 2013 Spring;18(1):12-6. doi: 10.5812/traumamon.7125. Epub 2013 May 26.
Diaphragmatic rupture due to blunt or penetrating injury may be a missed diagnosis in an acute setting and can present with a delayed complication with significantly increased morbidity and mortality.
The objective of this study is to better understand why diaphragmatic tears with delayed presentation and diagnosis are so often missed and why traumatic diaphragmatic tears are difficult to diagnose in emergency settings and how they present with grievous complications.
Eleven patients with diaphragmatic hernias with delayed presentation and delayed diagnosis were operated within the last five years. All patients presented with different complications like gut gangrene or respiratory distress.
Out of eleven patients who were operated on for diaphragmatic hernia, three patients (27%) died. Three patients required colonic resection, one patient needed gastrectomy and one patient underwent esophagogastrectomy.
A small diaphragmatic tear due to blunt trauma to the abdomen is difficult to diagnosis in acute settings due to ragged margins and possibly no herniated contents and usually present with a delayed complication. Therefore a careful examination of the entire traumatized area is the best approach in treating delayed presentation of traumatic diaphragmatic hernia prior to development of grievous complications.
钝性或穿透性损伤导致的膈肌破裂在急性情况下可能漏诊，并可能出现延迟性并发症，显著增加发病率和死亡率。
本研究的目的是更好地理解为何延迟出现和诊断的膈肌撕裂常常被漏诊，为何创伤性膈肌撕裂在急诊环境中难以诊断，以及它们如何出现严重并发症。
过去五年内，对11例出现延迟表现和延迟诊断的膈肌疝患者进行了手术。所有患者均出现不同并发症，如肠坏疽或呼吸窘迫。
接受膈肌疝手术的11例患者中，3例（27%）死亡。3例患者需要进行结肠切除术，1例患者需要进行胃切除术，1例患者接受了食管胃切除术。
腹部钝性创伤导致的小膈肌撕裂在急性情况下难以诊断，因为边缘参差不齐且可能没有疝入的内容物，通常会出现延迟性并发症。因此，在严重并发症发生之前，仔细检查整个创伤区域是治疗创伤性膈肌疝延迟表现的最佳方法。
