Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan.
BMJ Case Rep. 2020 Nov 4;13(11):e235870. doi: 10.1136/bcr-2020-235870.
Right-sided blunt traumatic diaphragmatic injury (TDI) is a rare injury that is rarely repaired by the minimally invasive approach in the acute setting. Laparoscopic repair of right-sided TDI is challenging because the liver often obstructs access to the injury site. Herein, we report a case wherein acute right-sided blunt TDI was successfully repaired using a combined laparoscopic and thoracoscopic approach. A 30-year-old man presented with shortness of breath after falling on his back while jumping on a snowboard. CT revealed a right-sided TDI. As the patient was haemodynamically stable, laparoscopic repair was planned. Laparoscopy revealed a right-sided diaphragmatic rupture. As the posterior portion was covered by the liver and difficult to access, we added trocars in the chest cavity and closed the diaphragmatic defect with a thoracic approach. A combined laparoscopic and thoracoscopic approach can repair right-sided diaphragmatic injury by a minimally invasive approach even in the acute setting.
右侧钝性创伤性横膈膜损伤（TDI）是一种罕见的损伤，在急性情况下很少通过微创方法进行修复。腹腔镜修复右侧 TDI 具有挑战性，因为肝脏常常妨碍进入损伤部位。在此，我们报告了一例使用腹腔镜和胸腔镜联合入路成功修复急性右侧钝性 TDI 的病例。一名 30 岁男性在滑雪板上跳跃时背部着地后出现呼吸急促。CT 显示右侧 TDI。由于患者血流动力学稳定，计划进行腹腔镜修复。腹腔镜检查发现右侧横膈膜破裂。由于后部被肝脏覆盖且难以接近，我们在胸腔内增加了套管，并通过胸腔入路闭合横膈膜缺损。即使在急性情况下，通过微创方法也可以使用腹腔镜和胸腔镜联合入路修复右侧横膈膜损伤。
