Nusretoğlu Resul, Dönder Yunus
Department of General Surgery, Hakkari Yüksekova State Hospital, Hakkari, Turkey.
Department of General Surgery, Kayseri City Training and Research Hospital, Health Science University, Kayseri, Turkey.
J Med Case Rep. 2021 Jan 23;15(1):19. doi: 10.1186/s13256-020-02606-3.
Diaphragmatic hernias may occur as either congenital or acquired. The most important cause of acquired diaphragmatic hernias is trauma, and the trauma can be due to blunt or penetrating injury. Diaphragmatic hernia may rarely be seen after thoracoabdominal trauma.
A 54-year-old Turkish male patient admitted to the emergency department with abdominal pain and dyspnea ongoing for 2 days. He had general abdominal tenderness in all quadrants. He had a history of a stabbing incident in his left subcostal region 3 months ago without any pathological findings in thoracoabdominal computed tomography scan. New thoracoabdominal computed tomography showed a diaphragmatic hernia and fluid in the hernia sac. Due to respiratory distress and general abdominal tenderness, the decision to perform an emergency laparotomy was made. There was a 6 cm defect in the diaphragm. There were also necrotic fluids and stool in the hernia sac in the thorax colon resection, and an anastomosis was performed. The defect in the diaphragm was sutured. The oral regimen was started, and when it was tolerated, the regimen was gradually increased. The patient was discharged on the postoperative 11th day.
Acquired diaphragmatic hernia may be asymptomatic or may present with complications leading to sepsis. In this report, acquired diaphragmatic hernia and associated colonic perforation of a patient with a history of stab wounds was presented.
膈疝可分为先天性或后天性。后天性膈疝的最重要原因是创伤，创伤可由钝性或穿透性损伤引起。胸腹创伤后很少能见到膈疝。
一名54岁的土耳其男性患者因腹痛和呼吸困难持续2天入住急诊科。他全腹有压痛。他3个月前在左肋下区域有刺伤史，胸腹计算机断层扫描未发现任何病理结果。新的胸腹计算机断层扫描显示膈疝和疝囊内有积液。由于呼吸窘迫和全腹压痛，决定进行急诊剖腹手术。膈肌有一个6厘米的缺损。疝囊内还有坏死液和粪便，进行了结肠切除和吻合术。膈肌缺损进行了缝合。开始口服治疗，当患者耐受时，逐渐增加治疗剂量。患者术后第11天出院。
后天性膈疝可能无症状，也可能出现导致败血症的并发症。本报告介绍了一名有刺伤史患者的后天性膈疝及相关结肠穿孔情况。
