Meskauskas Andrius, Goumard Claire
Department of Hepatobiliary Surgery and Liver Transplantation, Sorbonne Université, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Paris, France.
Radiol Case Rep. 2024 Oct 23;20(1):215-220. doi: 10.1016/j.radcr.2024.09.130. eCollection 2025 Jan.
Diaphragmatic hernias are a rare finding in adult population, especially in urgent settings. Nevertheless, the acute symptoms can be life-threatening and may require urgent surgical intervention. We report a rare case of a nontraumatic diaphragmatic hernia in a young adult with a history of laparotomy at the age of 1, suggesting a pre-existing malformation. The clinical presentation was dominated by respiratory symptoms and biological signs of hepatic ischemia, with no abdominal pain. Computed tomography demonstrated protrusion of the entire liver into the thoracic cavity. In this context, an emergency laparotomy was performed. The liver was reintroduced to the abdominal cavity, and the diaphragmatic defect repaired using a synthetic mesh, resulting in resolution of symptoms and a smooth postoperative recovery. Our case highlights the need for efficient diagnosis of the diaphragmatic hernias in adults, even without the context of trauma. A prompt and adequate repair of the defect, usually interposing a synthetic mesh, allows for complete and relatively fast recovery.
膈肌疝在成人中较为罕见，尤其是在急诊情况下。然而，急性症状可能危及生命，可能需要紧急手术干预。我们报告一例罕见的非创伤性膈肌疝病例，患者为一名年轻成人，1岁时曾接受剖腹手术，提示存在先天性畸形。临床表现以呼吸道症状和肝脏缺血的生物学体征为主，无腹痛。计算机断层扫描显示整个肝脏突入胸腔。在此情况下，进行了急诊剖腹手术。将肝脏重新放回腹腔，使用合成补片修复膈肌缺损，症状得以缓解，术后恢复顺利。我们的病例强调，即使没有创伤背景，也需要对成人膈肌疝进行有效诊断。及时且充分地修复缺损，通常使用合成补片，可实现完全且相对快速的恢复。
