PDF(Pubmed)
Abstract：
Traumatic diaphragmatic hernias (TDHs) can occur after both blunt and penetrating injury. Laparotomy and thoracotomy are commonly done for the management of TDHs. Minimally invasive surgery, especially laparoscopic surgery, is being accepted as an effective and safe alternative to open surgical repair even in trauma cases. Laparoscopy also allows for the detection and management of clinically occult TDHs, thereby preventing the complications of missed or delayed diagnosis. Our case highlights the importance of timely intervention with a minimally invasive approach. A 39-year-old male presented to the emergency room after a road traffic accident. Computed tomography scan confirmed left-sided diaphragmatic rupture with gastric herniation. Laparoscopic repair of the hernia was done. He had an uneventful post-operative period. At the one-year follow-up, he was asymptomatic and was doing well. TDHs have a variable clinical presentation and radiological findings are not always diagnostic. Such cases can progress to potentially life-threatening complications such as strangulation and perforation of the herniated viscera. Timely diagnosis and management are therefore essential. A minimally invasive approach such as laparoscopy should be used for the management of TDHs in the acute setting where the patient is stable, and resources are available. In this case, once the gastric contents were aspirated via a nasogastric tube in the middle of the night, the immediate need for surgery was converted to an urgent nature, and the patient underwent surgery the next morning in a more controlled setting. In addition, timely intervention can prevent future complications that may occur if the condition is left untreated during the initial admission.
摘要：
创伤性膈疝（TDHs）可在钝性和穿透性损伤后发生。剖腹手术和开胸手术通常用于TDHs的管理。微创手术,尤其是腹腔镜手术,即使在创伤病例中，也被认为是开放手术修复的有效和安全的替代方案。腹腔镜检查还可以检测和管理临床隐匿性TDHs，从而防止错过或延迟诊断的并发症。我们的案例强调了采用微创方法及时干预的重要性。一名39岁的男性在道路交通事故后出现在急诊室。计算机断层扫描证实左侧膈肌破裂伴胃疝。进行了腹腔镜疝修补术。他有一个平静的手术后时期。在为期一年的随访中，他没有症状，情况很好。TDHs具有可变的临床表现，放射学发现并不总是诊断性的。这种情况可能会发展为潜在的危及生命的并发症，例如绞窄和疝内脏穿孔。因此，及时的诊断和管理至关重要。在患者病情稳定的急性环境下，应使用腹腔镜等微创方法来管理TDHs，和资源是可用的。在这种情况下,一旦在半夜通过鼻胃管吸入胃内容物，手术的迫切需要转变为紧急性质，患者第二天早上在更可控的环境中接受了手术。此外,如果在初次入院期间不进行治疗,及时的干预可以预防将来可能发生的并发症.
