Omar Asaad Shareef, Musa Dildar Haji, Sgery Azri Salih Haji
Department of Surgery, College of Medicine, University of Duhok.
Directorate of Health, Duhok, Kurdistan Region, Iraq.
Ann Med Surg (Lond). 2024 Aug 7;86(9):5586-5589. doi: 10.1097/MS9.0000000000002415. eCollection 2024 Sep.
The pericardial hernia is a rarely encountered clinical condition characterized by the herniation of the abdominal viscera into the pericardial cavity. Trauma precedes the development of these hernias in most cases, yet iatrogenic intervention and congenital defects are other potential causes.
A male aged 60 years, with no history of previous trauma, presented with epigastric pain and was diagnosed with a case of STEMI. After the treatment, the patient continued to deteriorate and developed repeated vomiting. Surgical consultation was counseled which recommended a plain erect abdominal radiograph that revealed air-fluid levels. During surgery, the surgeon noticed a strangulated jejunum protruding into the pericardium, and the case was diagnosed as a pericardial hernia.
Pericardial hernias could be congenital or acquired and trauma is regarded as the commonest cause in adults. According to the history and clinical presentation the cause could be an old-forgotten trauma that has led to the small defect formation and protrusion of the jejunum. Trauma is regarded as the commonest cause; however, cases can pass unnoticed. The clinical presentation of this patient was initially related to acute coronary syndrome and was treated with primary coronary intervention, later a co-existing cause or probably the initiating cause was found to be a pericardial hernia.
The diagnosis of the case makes a significant challenge that requires a high index of suspicion due to the rarity of the condition, variable clinical presentation, and the delayed development of symptoms.
心包疝是一种临床罕见的病症，其特征为腹腔脏器疝入心包腔。多数情况下，外伤是这些疝形成的诱因，但医源性干预和先天性缺陷也是其他潜在病因。
一名60岁男性，既往无外伤史，因上腹部疼痛就诊，被诊断为ST段抬高型心肌梗死。治疗后，患者病情持续恶化并出现反复呕吐。经外科会诊，建议进行腹部立位平片检查，结果显示气液平面。手术过程中，外科医生发现一段绞窄的空肠突入心包，该病例被诊断为心包疝。
心包疝可分为先天性或后天性，外伤被认为是成人最常见的病因。根据病史和临床表现，病因可能是既往被遗忘的外伤导致小缺损形成，进而引起空肠突出。外伤被视为最常见的病因；然而，有些病例可能未被察觉。该患者最初的临床表现与急性冠状动脉综合征有关，并接受了冠状动脉介入治疗，后来发现并存的病因或可能的起始病因是心包疝。
由于该病症罕见、临床表现多样且症状出现延迟，该病例的诊断极具挑战性，需要高度的怀疑指数。
