Schulman A, Fataar S, Alheit B
S Afr Med J. 1985 Jul 6;68(1):39-44.
The radiological and clinical features of 9 cases of obstructed post-traumatic diaphragmatic hernia are reviewed. In none of these patients was the diagnosis of a diaphragmatic hernia considered before radiography, all cases being clinically diagnosed as 'acute abdomen', most frequently pancreatitis or perforated peptic ulcer. Even after radiographs had shown opacity at the left base in all 9 cases, together with a distended proximal bowel in 6, the correct diagnosis was made in only 4. Through lack of correct radiological diagnosis, there was a delay of at least 1 day between admission and operation in 6 patients, and 3 of the 4 deaths occurred in this group. Obstruction-strangulation of diaphragmatic hernia should be considered as a possible cause of 'acute abdomen' in the presence of a left basal abnormality, especially in patients from areas with a high incidence of assault. Confirmatory contrast studies should be done only if they can be done immediately and quickly. Pregnancy can cause hernias to become obstructed and strangulated, but this can be averted by obtaining a history of previous trauma early in the pregnancy.
回顾了9例创伤后梗阻性膈疝的放射学和临床特征。在这些患者中，没有一例在进行放射检查之前考虑过膈疝的诊断，所有病例临床诊断均为“急腹症”，最常见的是胰腺炎或消化性溃疡穿孔。即使9例患者的X光片均显示左膈底部有不透明影，且6例近端肠管扩张，但只有4例做出了正确诊断。由于缺乏正确的放射学诊断，6例患者在入院和手术之间至少延迟了1天，4例死亡患者中有3例发生在这一组。在左膈底部有异常的情况下，尤其是在袭击发生率高的地区的患者中，应考虑膈疝梗阻绞窄是“急腹症”的可能原因。仅当能立即快速进行时，才应进行确诊性造影检查。妊娠可导致疝发生梗阻和绞窄，但可通过在妊娠早期了解既往创伤史来避免这种情况。
