Innes Rebecca, Kulkarni Mohan
Surgery, Henry Ford Health System, Jackson, USA.
Thoracic Surgery, Henry Ford Health System, Jackson, USA.
Cureus. 2021 Aug 9;13(8):e17028. doi: 10.7759/cureus.17028. eCollection 2021 Aug.
Motor vehicle collisions (MVC) cause more than one million deaths annually and an estimated 20-50 million significant injuries. They can cause blunt and penetrating trauma. Blunt diaphragmatic rupture is generally associated with multiple severe injuries due to the high force needed to cause the injury. Traumatic diaphragmatic rupture (TDR) is normally identified during advance trauma life support (ATLS) secondary survey, after other more serious injuries are identified in the primary survey. We present a case of a patient who was involved in a MVC with multiple injuries, which were treated appropriately, prior to identification and treatment of a severe right-sided diaphragm injury. Imaging showed only a persistent right hemidiaphragm elevation. Intra-operative findings consisted of complete herniation of the liver with a Grade IV, 30 cm, right-sided diaphragmatic rupture. The herniated liver was repositioned and the diaphragm primarily repaired without complication. This case highlights a severe injury from a blunt MVC and rapid successful recovery of the patient once appropriately treated.
机动车碰撞（MVC）每年导致超过100万人死亡，估计有2000万至5000万人受重伤。它们可造成钝性和穿透性创伤。钝性膈肌破裂通常与多种严重损伤相关，因为造成这种损伤需要很大的力量。创伤性膈肌破裂（TDR）通常在高级创伤生命支持（ATLS）二次评估期间被发现，此前在初次评估中已识别出其他更严重的损伤。我们报告一例患者，该患者在机动车碰撞事故中多处受伤，在识别和治疗严重的右侧膈肌损伤之前，这些损伤均得到了适当治疗。影像学检查仅显示右半膈肌持续抬高。术中发现肝脏完全疝出，伴有IV级、30厘米长的右侧膈肌破裂。将疝出的肝脏复位，膈肌进行一期修复，未出现并发症。该病例突出了钝性机动车碰撞造成的严重损伤，以及患者在得到适当治疗后迅速成功康复的情况。
