Chern Tien Yew, Kwok Allan, Putnis Soni
Department of Surgery, Wollongong Hospital, Locked Bag 8808, South Coast Mail Centre, NSW, 2521, Australia.
Surg Case Rep. 2018 Apr 20;4(1):37. doi: 10.1186/s40792-018-0447-y.
Traumatic diaphragmatic injuries from blunt or penetrating trauma are difficult to detect in the acute setting and, if missed, can result in significant morbidity and mortality in the future. We present a case demonstrating the natural progression of this resulting in faecopneumothorax, which is a rare but serious presentation.
A 22-year-old young man presented with left upper quadrant and chest pain, nausea, vomiting, and intermittent obstipation with a background of previous lower chest wall stabbings. Computed tomography demonstrated a diaphragmatic hernia containing the splenic flexure of the colon, but he declined treatment and self-discharged. He presented three more times with similar symptoms and self-discharged within a 2-week period and finally presented dyspnoeic and septic. Computed tomography demonstrated tension faecopneumothorax from the perforated colon. He was taken to theatres and found to have a 3-mm perforation at his splenic flexure and underwent a segmental resection of the affected colon, intrathoracic washout, and biological mesh repair of his diaphragmatic hernia. He remained alive and postoperative recovery was uneventful.
A review of the literature demonstrates the rarity of traumatic diaphragmatic injuries resulting in faecopneumothorax with only a few case reports in the last 50 years. We present a case demonstrating a natural progression of the condition and highlight the importance of having a high index of suspicion of diaphragmatic injuries in the trauma setting.
钝性或穿透性创伤导致的创伤性膈肌损伤在急性期难以检测，如果漏诊，未来可能导致严重的发病率和死亡率。我们报告一例病例，展示了其导致粪气胸的自然病程，这是一种罕见但严重的表现。
一名22岁青年男性，有左下胸壁刺伤史，现出现左上腹和胸痛、恶心、呕吐及间歇性便秘。计算机断层扫描显示膈肌疝，疝内容物为结肠脾曲，但他拒绝治疗并自行出院。在2周内他又因类似症状三次就诊并自行出院，最终出现呼吸困难和脓毒症。计算机断层扫描显示结肠穿孔导致张力性粪气胸。他被送往手术室，发现脾曲有一个3毫米的穿孔，接受了受累结肠的节段性切除、胸腔冲洗及膈肌疝生物补片修补术。他存活下来，术后恢复顺利。
文献回顾显示，创伤性膈肌损伤导致粪气胸非常罕见，过去50年仅有少数病例报告。我们报告一例病例展示了该病的自然病程，并强调在创伤情况下对膈肌损伤保持高度怀疑的重要性。
