Gumbs M A, Pai N, Trocino A
J Trauma. 1986 Nov;26(11):1053-5. doi: 10.1097/00005373-198611000-00017.
A 16-year-old male presented with a hemopneumothorax following a gunshot wound to the left chest. He was treated effectively with closed suction drainage for 48 hours when he suddenly complained of severe left chest pain. Preoperative diagnosis was suggestive of a traumatic diaphragmatic hernia but operative findings were confirmatory of a rare hernia through the foramen of Bochdalek. Chest X-ray showing a gas-filled viscus above the diaphragm is diagnostic. Increased abdominal pressure generated when he was first hit by the bullet and aggravated by increased negative intrapleural pressure resulting from suction drainage of the hemothorax is the probable mechanism of the herniation.
一名16岁男性因左胸部枪伤后出现血气胸。他接受了48小时的闭式引流治疗，效果良好，之后突然诉说左胸剧痛。术前诊断提示创伤性膈疝，但手术结果证实为通过Bochdalek孔的罕见疝。胸部X线显示膈肌上方有充气脏器即可诊断。首次被子弹击中时产生的腹压增加，以及血胸闭式引流导致的胸膜腔内负压增加使其加重，可能是疝形成的机制。
