Elyasinia Fezzeh, Emami Razavi Hassan, Hosseini Alireza, Abolhasanizade Firoozeh, Matloub Reza, Behboudi Behnam, Ahmadi Farham
Department of Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Acta Med Iran. 2017 Nov;55(11):730-732.
Complications of hiatal hernia are potentially lethal, and surgical intervention is necessary. This matter is more important in cases that have ambiguous symptoms and are diagnosed with a delay. Such patients may experience life-threatening course and events. Accordingly, in this report, a 23-year-old male patient with unusual findings is presented. A 23-year-old male patient with acute dyspnea and fever was admitted in infectious disease ward with diagnosis of empyema according to chest radiography and CT-scan findings (Figures 1 and 2). On physical examinations the right lung sounds were normal, and the left lung sounds could not be heard. Then a gastrography was performed because of suspicion to hiatal hernia based on physical examination findings showing the presence of stomach in the thorax (Figure 3). In the surgery, the stomach and the transverse colon were released and reputed in the abdomen (Figure 4). The diaphragm was primarily repaired due to small defect, and the patient was discharged after 4-5 days with good general conditions. This case had a learning note that in the case of acute dyspnea with a positive history of stab wound to the chest, hiatal hernia should be considered as an important diagnosis and in these cases performing a gastrography would help physicians to make true and certain diagnosis and therapeutic decision.
食管裂孔疝的并发症可能危及生命，因此手术干预是必要的。在症状不明确且诊断延迟的情况下，这一问题更为重要。此类患者可能经历危及生命的病程和事件。因此，在本报告中，介绍了一名有异常发现的23岁男性患者。一名23岁急性呼吸困难和发热的男性患者因胸部X线和CT扫描结果（图1和图2）被诊断为脓胸而入住传染病病房。体格检查时右肺呼吸音正常，左肺呼吸音未闻及。基于体格检查发现胸部有胃存在而怀疑食管裂孔疝，随后进行了胃造影（图3）。手术中，将胃和横结肠松解并放回腹腔（图4）。由于膈肌缺损较小，进行了一期修复，患者在4至5天后状况良好出院。该病例有一个经验教训，即在有胸部刺伤阳性病史的急性呼吸困难病例中，应将食管裂孔疝视为重要诊断，在这些病例中进行胃造影将有助于医生做出准确可靠的诊断和治疗决策。
