Department of Thoracic Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
BMJ Case Rep. 2021 Nov 30;14(11):e247189. doi: 10.1136/bcr-2021-247189.
A 70-year-old asthmatic man presented with a history of chronic intermittent left-sided chest pains and a bulge-like deformity of his chest which became more prominent with expiration. He sustained a traumatic fall 2 years prior whereby he fractured his right humerus at the surgical neck, requiring total arthroplasty. Examination and CT imaging of the thorax revealed a left costal arch fracture with hemidiaphragm rupture and associated transperitoneal fat herniation. He underwent left thoracolaparotomy with costal arch and diaphragmatic hernia repair. He was discharged 48 hours postoperatively and is satisfied with good outcomes under initial follow-up. This case report highlights the surgical management of a condition that usually presents late after significant trauma and may progress to visceral strangulation if untreated.
一位 70 岁的哮喘患者，有慢性间歇性左侧胸痛病史，且胸部有向外突出的肿胀样畸形，呼气时更为明显。他在 2 年前遭受了外伤性摔倒，导致右侧肱骨外科颈骨折，需要进行全关节置换。胸部检查和 CT 成像显示左侧肋弓骨折伴横膈破裂和相关腹膜后脂肪疝出。他接受了左胸腹腔镜切开术，进行肋弓和横膈疝修补术。术后 48 小时出院，在最初的随访中恢复良好，感到满意。本病例报告强调了一种通常在严重创伤后晚期出现的疾病的手术治疗方法，如果不治疗，可能会进展为内脏绞窄。
