Henzler M, Martin M L, Young J
Division of Emergency Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania 15212.
Ann Emerg Med. 1988 Apr;17(4):350-3. doi: 10.1016/s0196-0644(88)80780-7.
We present a case of delay in diagnosis of diaphragmatic rupture and herniation in a pregnant 25-year-old woman. The diaphragmatic rupture was secondary to trauma sustained five months prior to presentation. Subsequent to her accident, she was provided medical care on multiple occasions for symptoms of intractable nausea, vomiting, and weight loss that were probably related to an expanding uterus and diaphragmatic herniation of abdominal contents. At the time she presented to us the herniation had progressed and she was experiencing severe respiratory difficulty. A nasogastric tube was placed for diagnosis and decompression. A chest radiograph provided the diagnosis of herniation of gastrointestinal contents through the left hemidiaphragm. A healthy 5-lb boy was delivered vaginally and subsequently a left thoracotomy was performed for decompression and repair of the diaphragm. The patient's hospital course after hernia repair was uneventful.
我们报告一例25岁孕妇膈破裂和疝的诊断延误病例。膈破裂继发于就诊前五个月遭受的创伤。事故发生后，她因顽固性恶心、呕吐和体重减轻等症状多次接受治疗，这些症状可能与子宫增大和腹腔内容物膈疝有关。她前来就诊时，疝已进展，且出现严重呼吸困难。放置鼻胃管用于诊断和减压。胸部X线片确诊为胃肠道内容物经左半膈疝出。经阴道分娩出一个健康的5磅重男婴，随后行左胸廓切开术进行减压和膈肌修复。疝修补术后患者的住院过程平稳。
