Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University Medical School "Aldo Moro" of Bari, Bari, Italy.
Department of Thoracic Surgery, University of Bari, Bari, Italy.
World J Emerg Surg. 2017 May 18;12:23. doi: 10.1186/s13017-017-0134-5. eCollection 2017.
Congenital diaphragmatic hernia (CDH) is a congenital abnormality, rare in adults with a frequency of 0.17-6%. Diaphragmatic rupture is an infrequent consequence of trauma, occurring in about 5% of severe closed thoraco-abdominal injuries. Clinical presentation ranges from asymptomatic cases to serious respiratory or gastrointestinal symptoms. Diagnosis depends on anamnesis, clinical signs and radiological investigations.
From May 2013 to June 2016, six cases (four females, two males; mean age 58 years) of diaphragmatic hernia were admitted to our Academic Department of General Surgery with respiratory and abdominal symptoms. Chest X-ray, barium studies and CT scan were performed.
Case 1 presented left diaphragmatic hernia containing transverse and descending colon. Case 2 showed left CDH which allowed passage of stomach, spleen and colon. Case 3 and 6 showed stomach in left hemithorax. Case 4 presented left diaphragmatic hernia which allowed passage of the spleen, left lobe of liver and transverse colon. Case 5 had stomach and spleen herniated into the chest. Emergency surgery was always performed. The hernia contents were reduced and defect was closed with primary repair or mesh. In all cases, post-operative courses were uneventful.
Overlapping abdominal and respiratory symptoms lead to diagnosis of diaphragmatic hernia, in patients with or without an history of trauma. Chest X-ray, CT scan and barium studies should be done to evaluate diaphragmatic defect, size, location and contents. Emergency surgical approach is mandatory reducing morbidity and mortality.
先天性膈疝（CDH）是一种先天性异常，在成年人中很少见，发病率为 0.17-6%。膈破裂是创伤的罕见后果，约占严重闭合性胸腹损伤的 5%。临床表现从无症状病例到严重的呼吸或胃肠道症状不等。诊断取决于病史、临床体征和影像学检查。
从 2013 年 5 月至 2016 年 6 月，我们的普通外科学术部门收治了 6 例（女性 4 例，男性 2 例；平均年龄 58 岁）有呼吸和腹部症状的膈疝患者。进行了胸部 X 线、钡餐检查和 CT 扫描。
病例 1 表现为包含横结肠和降结肠的左侧膈疝。病例 2 显示左侧 CDH，允许胃、脾和结肠通过。病例 3 和 6 显示胃位于左侧胸腔。病例 4 表现为左侧膈疝，允许脾、肝左叶和横结肠通过。病例 5 表现为胃和脾疝入胸腔。总是进行紧急手术。疝内容物被还原，缺损用原发性修复或网片关闭。所有病例的术后过程均无并发症。
腹部和呼吸症状重叠导致膈疝的诊断，无论患者是否有创伤史。应进行胸部 X 线、CT 扫描和钡餐检查，以评估膈缺损、大小、位置和内容物。紧急手术方法是强制性的，可以降低发病率和死亡率。
