Fasolini F, Aeberhard P
Chirurgische Klinik, Kantonsspital Aarau.
Helv Chir Acta. 1994 Dec;60(6):907-11.
Traumatic avulsion of the right diaphragm from the lumbocostal arch is a very rare lesion. The authours report the case of a 27-year-old man who had suffered a severe polytrauma with blunt thoracic injury, fracture of the lumbar spine, Malgaigne-type fracture of the pelvis and fracture of the femoral shaft on the right side, 10 years before. At the time of injury the lesion of the diaphragm went unnoticed. The diagnosis was made 10 years later when the patient was referred for chronic right thoracic pain combined with postprandial abdominal distension and crampy pain in the abdomen. The chest radiogram and CT-scan showed displacement of the right kidney and most of the right colon into the thorax due to avulsion of the diaphragm from its dorsal insertion on the lumbocostal arch. Surgical repair was necessary to obtain relief from pain and to prevent intestinal obstruction. Reduction of the hernia, reinsertion of the diaphragm to the lumbocostal arch and reinforcement of the repair with a prolene mesh prosthesis was performed through a right thoracophrenolumbotomy incision.
右膈从腰肋弓处创伤性撕脱是一种非常罕见的损伤。作者报告了一例27岁男性病例，该患者在10年前曾遭受严重多发伤，包括钝性胸部损伤、腰椎骨折、马尔盖尼型骨盆骨折和右侧股骨干骨折。受伤时，膈的损伤未被发现。10年后，当患者因慢性右胸痛伴餐后腹胀和腹部绞痛前来就诊时，做出了诊断。胸部X线片和CT扫描显示，由于膈从其在腰肋弓的背侧附着处撕脱，右肾和大部分右结肠移位至胸腔。为缓解疼痛并预防肠梗阻，需要进行手术修复。通过右侧胸膈腰切口进行疝还纳、将膈重新固定至腰肋弓，并使用聚丙烯网片假体加强修复。
