Pace Marco, Vallati Damiano, Belloni Elena, Cavallini Marco, Ibrahim Mohsen, Rendina Erino Angelo, Nigri Giuseppe
General Surgery Unit, Department of Medical and Surgical Sciences and Translational Medicine, St. Andrea University Hospital, Sapienza University of Rome, Rome, Italy.
Thoracic Surgery Unit, Department of Medical and Surgical Sciences and Translational Medicine, St. Andrea University Hospital, Sapienza University of Rome, Rome, Italy.
Front Surg. 2021 Dec 1;8:772913. doi: 10.3389/fsurg.2021.772913. eCollection 2021.
A bilateral diaphragmatic rupture is a rare event that occurs in cases of blunt thoracic-abdominal trauma. We report the case of a 56-year-old female patient with pelvic fracture and second-stage bilateral rupture of the diaphragm due to a car accident. After a chest and abdominal contrast-enhanced computed tomography (CT) scan, the patient underwent emergency suturing of the left hemidiaphragm. On postoperative day (POD) 4, a CT scan performed due to the sudden onset of dyspnea revealed rupture of the right hemidiaphragm, which was not detected on the preoperative CT scan. On POD 9, the right hemidiaphragm was repaired with mesh during a right thoracotomy. The patient recovered 14 days after surgery. However, the postoperative course was complicated by an asymptomatic COVID-19 infection that significantly delayed her discharge from the hospital. Difficulties in preoperative diagnosis and treatment, together with the lack of data in the literature, make this type of trauma a challenge for all acute care and general surgeons.
双侧膈肌破裂是一种罕见的情况,发生于钝性胸腹联合伤。我们报告一例56岁女性患者,因车祸导致骨盆骨折及二期双侧膈肌破裂。经胸部和腹部增强计算机断层扫描(CT)后,患者接受了左半膈肌的紧急缝合。术后第4天,因突然出现呼吸困难进行的CT扫描显示右半膈肌破裂,术前CT扫描未检测到。术后第9天,在右开胸手术中用补片修复了右半膈肌。患者术后14天康复。然而,术后过程因无症状新冠病毒感染而复杂化,这显著延迟了她出院。术前诊断和治疗的困难,以及文献中数据的缺乏,使这类创伤对所有急症科医生和普通外科医生而言都是一项挑战。