Abd Elrazek Abd Elrazek, Shehab Abdullah, Elnour Asim A, Al Nuaimi Saif K, Baghdady Shazly
From the Division of Liver Transplantation and Liver Research, Gastroenterology and Hepatology Department (AEAE), Faculty of Medicine, Al-Azhar University, Egypt; Cardiovascular Medicine Department (AS); Pharmacology Department (AAE), Faculty of Medicine and Health Sciences; Department of internal medicine (SKAN), United Arab Emirates University, United Arab Emirates; and Chest and ICU Department (SB), Faculty of Medicine, Aswan University, Egypt.
Medicine (Baltimore). 2015 Feb;94(6):e507. doi: 10.1097/MD.0000000000000507.
Diaphragmatic injury is an uncommon traumatic injury (<1%). Although most diaphragmatic injuries can be obvious (eg, herniation of abdominal contents on chest radiograph), some injuries may be subtle and imaging studies can be nondiagnostic in many situations. Patients with diaphragmatic hernia either traumatic or nontraumatic may initially have no symptoms or signs to suggest an injury to the diaphragm.Here, we report a case of a 75-year-old woman diagnosed with irritable bowel syndrome -associated dominant constipation, presented with shortness of breath, cough, expectoration, tachycardia, and chest pain. Dextrocardia was an incidental finding, diagnosed by electrocardiography, chest radiograph, and CT chest. Parts of the colon, small intestine, and stomach were within the thorax in the left side due to left diaphragmatic hernia of a nontraumatic cause. Acquired incidental dextrocardia was the main problem due to displacement of the heart to contralateral side by the GI (gastrointestinal) viscera (left diaphragmatic hernia).The patient was prepared for the laparoscopic surgical repair, using a polyethylene mesh 20 cm to close the defect, and the patient recovered with accepted general condition. However, 5 days postoperative, the patient passed away suddenly due to unexplained cardiac arrest.Intrathoracic herniation of abdominal viscera should be considered in patients presented with sudden chest pain concomitant with a history of increased intra-abdominal pressure.
膈肌损伤是一种罕见的创伤性损伤（<1%）。尽管大多数膈肌损伤可能很明显（例如，胸部X线片显示腹腔内容物疝出），但有些损伤可能很隐匿，在许多情况下影像学检查可能无法确诊。患有创伤性或非创伤性膈肌疝的患者最初可能没有症状或体征提示膈肌损伤。在此，我们报告一例75岁女性病例，该患者诊断为肠易激综合征相关的主要便秘，出现呼吸急促、咳嗽、咳痰、心动过速和胸痛。右位心是偶然发现的，通过心电图、胸部X线片和胸部CT诊断。由于非创伤性原因导致的左侧膈肌疝，部分结肠、小肠和胃位于左侧胸腔内。由于胃肠道（GI）内脏（左侧膈肌疝）将心脏移位至对侧，获得性偶然右位心是主要问题。该患者准备接受腹腔镜手术修复，使用20厘米的聚乙烯网片关闭缺损，患者术后一般情况恢复良好。然而，术后5天，患者因不明原因的心搏骤停突然死亡。对于出现突发胸痛且有腹腔内压力升高病史的患者，应考虑腹腔内脏器胸腔内疝。
