Department of Pediatric, Clinical Research Development Center of Children Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
Student Research Committee, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
J Med Case Rep. 2022 Mar 15;16(1):104. doi: 10.1186/s13256-022-03331-9.
Congenital diaphragmatic hernia affects 1 in every 2000-5000 live births. The mediastinum shifts to the opposite side, the lungs are hypoplastic, and the arterioles are abnormal, resulting in pulmonary hypertension. Respiratory and cardiovascular functions are severely impaired at birth, resulting in significant mortality and morbidity as a result of the associated malformations.
A 9-year-old persian boy was referred with complaint of intermittent abdominal pain in the left lower quadrant and an episode of vomiting. The patient was tachypneic, and the abdomen was nontender on examination. Lung sounds on the left side were considerably decreased, whereas heart sounds on the right side were louder. There was no history of underlying disease in the patient. Initial laboratory blood tests, chest x-ray, spiral computed tomography scan, and chest sonography were requested. Blood tests were normal, and chest x-ray revealed a round-shaped lesion with relatively clear boundaries containing air-fluid level and shift of the heart and mediastinum to the right. A spiral computed tomography scan of the lungs demonstrated the shift of the heart and mediastinum to the right side was due to dilated stomach and colon pressure, and chest sonography revealed that half of the stomach was inside the thorax. Laparotomy surgery was performed. The patient had no complications following surgery.
Herniation of abdominal contents through the diaphragmatic hiatus should be suspected in patients with tachypnea and mediastinal shift to the right side. Rapid diagnosis and early surgical treatment are necessary to avert any potentially life-threatening complications.
先天性膈疝的发病率为每 2000-5000 例活产儿中就有 1 例。纵隔向对侧移位，肺发育不全，小动脉异常，导致肺动脉高压。出生时呼吸和心血管功能严重受损，导致严重的死亡率和发病率，这是由于相关畸形引起的。
一名 9 岁的波斯男孩因左侧下腹部间歇性疼痛和呕吐就诊。患者呼吸急促，腹部检查无压痛。左侧肺部听诊明显减弱，而右侧心音增强。患者无潜在疾病史。最初要求进行实验室血液检查、胸部 X 射线检查、螺旋 CT 扫描和胸部超声检查。血液检查正常，胸部 X 射线显示圆形病变，边界相对清晰，内含气液平面，伴有心脏和纵隔向右侧移位。肺部螺旋 CT 扫描显示心脏和纵隔向右侧移位是由于扩张的胃和结肠压力所致，胸部超声显示一半的胃在胸腔内。行剖腹手术。术后患者无并发症。
对于呼吸急促和纵隔向右侧移位的患者，应怀疑有腹部内容物通过横膈裂孔疝出。快速诊断和早期手术治疗对于避免任何潜在的危及生命的并发症是必要的。
