Chapman Alexander A, Duff Steven B
Department of General Surgery, Riverside Methodist Hospital, Columbus, OH 43214, USA.
OhioHealth Heart, Lung and Vascular Surgeons, Riverside Methodist Hospital, Columbus, OH 43214, USA.
Case Rep Surg. 2017;2017:7416092. doi: 10.1155/2017/7416092. Epub 2017 Feb 23.
This case report discusses the diagnosis and management of a 67-year-old male presenting with a spontaneous transdiaphragmatic intercostal hernia with contralateral intercostal hernia. The patient had a history of chronic obstructive pulmonary disease (COPD) exacerbations requiring multiple prolonged courses of steroids. The patient was ultimately diagnosed with computed tomography (CT) and underwent surgical repair via thoracotomy with primary repair of the diaphragmatic defect. The patient's postoperative course was uncomplicated. A review of the literature since the first similar case in 1977 recognizes the propensity of this injury to be found in patients with COPD and chronic steroid usage, as well as its diagnosis and management. The case reviewed is the second documented case of a concurrent abdominal wall herniation and the first one with a contralateral injury. It is important for clinicians to be aware of this pathology when evaluating patients with COPD and chronic steroid usage.
本病例报告讨论了一名67岁男性患者的诊断和治疗情况，该患者患有自发性经膈肋间疝并伴有对侧肋间疝。患者有慢性阻塞性肺疾病（COPD）加重病史，需要多次长期使用类固醇治疗。患者最终通过计算机断层扫描（CT）确诊，并接受了开胸手术修复，对膈肌缺损进行了一期修复。患者术后恢复过程顺利。自1977年首例类似病例以来的文献回顾显示，这种损伤在患有COPD和长期使用类固醇的患者中较为常见，同时也介绍了其诊断和治疗方法。该病例是有记录的第二例并发腹壁疝的病例，也是首例伴有对侧损伤的病例。临床医生在评估患有COPD和长期使用类固醇的患者时，了解这种病理情况非常重要。
