van Loenhout R M, Carol E J, Lubbers E J, Reinders J F, van der Werken C
Abteilung für Chirurgie, St. Elisabeth Krankenhaus, Tilburg.
Unfallchirurgie. 1987 Oct;13(5):271-3. doi: 10.1007/BF02588508.
The histories of 67 patients with a diaphragmatic rupture due to blunt trauma were reviewed in four hospitals. In 45 patients the diagnosis was made within 24 hours after the accident, in the other 22 patients the rupture was diagnosed in a later stage. In the first group there were much abdominal injuries and during emergency laparotomy for some other reasons in 29% of these cases the diaphragmatic rupture was found accidentally. Not recognizing a rupture in the acute phase and therefore delaying operation was caused by the fact that the initial chest X-ray was not thoroughly checked for signs of a diaphragmatic rupture. The reasons for operation in the "delayed" group were mainly typical abnormalities for diaphragmatic rupture of the chest X-rays and other investigations proving the diagnosis. Only in one patient the delay in diagnosis has led to a very serious complication: because of incarceration with gangrene of a part of the small bowel it was necessary to remove this part. The other 21 patients in the group where the diagnosis was initially missed did not suffer from any serious complication.
回顾了四家医院67例因钝性创伤导致膈肌破裂患者的病史。45例患者在事故发生后24小时内确诊，另外22例患者在后期确诊。第一组腹部损伤较多，其中29%的病例在因其他原因进行急诊剖腹手术时意外发现膈肌破裂。急性期未识别出破裂从而导致手术延迟，原因是最初的胸部X光片未彻底检查有无膈肌破裂迹象。“延迟”组的手术原因主要是胸部X光片及其他检查显示出膈肌破裂的典型异常从而确诊。仅1例患者诊断延迟导致了非常严重的并发症：因部分小肠嵌顿伴坏疽，不得不切除该部分小肠。最初漏诊的该组其他21例患者未出现任何严重并发症。
