Koh H, Sivarajah S, Anderson D, Wilson C
Victoria Infrimary, Glasgow, UK.
J Surg Case Rep. 2012 Oct 1;2012(10):4. doi: 10.1093/jscr/2012.10.4.
Diaphragmatic hernias are usually congenital, and they usually occur in the neonatal group. They do occur in the adult population, albeit very rarely. We present a case of an adult male patient with complications as a result of a congenital diaphragmatic hernia. The patient presented with atypical abdominal pain and respiratory distress. Radiological investigations confirmed a left hydropneumothorax as well as large bowel obstruction secondary to herniation of the omentum and transverse colon through a congenital defect in the left hemi-diaphragm. He had a laparotomy, which confirmed the radiological findings and a perforated transverse colon. He went onto have an extended right hemicolectomy and end-ileostomy; his left hemithorax was lavaged and a thoracostomy tube was inserted. He recovered well, except that he developed an empyema postoperatively for which he required a thoracotomy and decortication. He made good recovery following this and was discharged home nine days following his initial laparotomy.
膈疝通常是先天性的，多见于新生儿群体。成人也会发生膈疝，不过极为罕见。我们报告一例成年男性患者，因先天性膈疝出现并发症。该患者表现为非典型腹痛和呼吸窘迫。影像学检查证实存在左侧液气胸以及因大网膜和横结肠通过左侧半膈肌先天性缺损疝出导致的大肠梗阻。患者接受了剖腹探查术，术中所见证实了影像学检查结果，还发现横结肠穿孔。随后他接受了扩大右半结肠切除术和末端回肠造口术；对其左胸腔进行了灌洗并插入了胸腔引流管。他恢复良好，只是术后并发了脓胸，为此又接受了开胸胸膜剥脱术。此后他恢复良好，在初次剖腹探查术后九天出院。
