Abu Halimah Jalal
Department of Surgery, Faculty of Medicine, Jazan University, Saudi Arabia; Centre for Minimal Access Surgery (CMAS), McMaster University, Canada.
Int J Surg Case Rep. 2023 Oct;111:108816. doi: 10.1016/j.ijscr.2023.108816. Epub 2023 Sep 17.
Post-Traumatic Diaphragmatic Hernia (PTDH) is a relatively uncommon condition, often a consequence of blunt or penetrative trauma to the thoracic or abdominal cavity. Its onset can be either immediate or delayed following the injury, typically presenting with the herniation of abdominal organs into the thoracic cavity. Large Bowel Obstruction (LBO) is an infrequent manifestation of PTDH. Here, we report a case of late PTDH presenting with LBO that was successfully managed through a laparoscopic approach.
A 49-year-old male patient presented with symptoms indicative of LBO seven years after sustaining a penetrative thoracoabdominal injury. Computed Tomography (CT) of his abdomen and pelvis revealed an incarcerated colon within a left diaphragmatic hernia, further corroborated by a significant history of a past thoracoabdominal stab wound. Diagnostic laparoscopy confirmed the diagnosis, which facilitated the relief of obstruction and repair of the diaphragmatic hernia. The patient exhibited a smooth recovery post-surgery without complications.
An LBO presenting as a consequence of a post-traumatic diaphragmatic hernia is indeed rare. Given the mechanical nature of the obstruction, surgical intervention is the primary treatment strategy.
Our case demonstrates that a laparoscopic approach is a safe and viable method for managing this condition.
创伤后膈疝（PTDH）是一种相对罕见的病症，通常是胸腔或腹腔钝性或穿透性创伤的结果。其发病可在受伤后立即出现或延迟出现，典型表现为腹腔脏器疝入胸腔。大肠梗阻（LBO）是PTDH的一种罕见表现。在此，我们报告一例以LBO为表现的迟发性PTDH病例，该病例通过腹腔镜手术成功治疗。
一名49岁男性患者在遭受穿透性胸腹伤7年后出现提示LBO的症状。其腹部和骨盆的计算机断层扫描（CT）显示左侧膈疝内有一段嵌顿结肠，既往胸腹刺伤史进一步证实了这一点。诊断性腹腔镜检查确诊了病情，这有助于解除梗阻并修复膈疝。患者术后恢复顺利，无并发症。
创伤后膈疝导致的LBO确实罕见。鉴于梗阻的机械性本质，手术干预是主要的治疗策略。
我们的病例表明，腹腔镜手术是治疗这种病症的一种安全可行的方法。
