Holder Paxton, Bakeer Mohamed-Aly
Department of Clinical Affairs, Edward Via College of Osteopathic Medicine, Monroe, LA, United States.
The Surgery Clinic of Northeast Louisiana and the Department of Surgery at Saint Francis Medical Center, Monroe, LA, United States.
J Surg Case Rep. 2024 Apr 1;2024(4):rjae197. doi: 10.1093/jscr/rjae197. eCollection 2024 Apr.
Traumatic diaphragmatic hernia is a sign of severe thoracoabdominal trauma that is often difficult to detect because of nonspecific presenting symptoms, delayed presentation, and distracting injuries. Diagnosis depends on imaging and a high degree of suspicion in patients who present with respiratory or gastrointestinal symptoms after trauma, and prompt surgical repair is required. This case reviews a patient who presented to the emergency department with burning epigastric pain radiating to the left chest and hematemesis ~1 month after sustaining a blunt abdominal injury. Imaging studies revealed a substantial portion of the gastric body in the left hemithorax. Robot-assisted reduction of the stomach was performed followed by repair with tension-free primary closure without mesh reinforcement and gastropexy. The patient was monitored for return of bowel function and discharged upon recovery. This case report highlights the diagnostic challenges of traumatic diaphragmatic hernia and the benefit of robot-assisted repair.
创伤性膈疝是严重胸腹创伤的一种表现,由于其症状不具特异性、就诊延迟以及合并其他易分散注意力的损伤,常常难以被发现。诊断依赖于影像学检查以及对创伤后出现呼吸或胃肠道症状患者的高度怀疑,并且需要及时进行手术修复。本病例回顾了一名患者,该患者在钝性腹部损伤约1个月后因上腹部烧灼样疼痛放射至左胸并伴有呕血而就诊于急诊科。影像学检查显示胃体大部分位于左胸腔。采用机器人辅助将胃回纳,随后进行无张力一期缝合修补,未使用补片加强,并行胃固定术。对患者的肠功能恢复情况进行监测,康复后出院。本病例报告强调了创伤性膈疝的诊断挑战以及机器人辅助修复的益处。