Traumatic diaphragmatic rupture through the central tendon with herniation of the stomach and coils of small bowel into the pericardial cavity.
Traumatic diaphragmatic rupture through the central tendon with herniation of the stomach and coils of small bowel into the pericardial cavity.
复制标题
创伤性膈肌穿过中央肌腱破裂，胃和小肠线圈疝入心包腔。
作者：
I. Nwafor;J. Eze;M. Aminu
未标记
创伤性胃破裂穿过中央腱，伴有胃疝和小肠弹簧圈进入心包腔。
方法
使用了一名患者的病例记录，该患者通过中央肌腱治疗创伤性血管破裂伴胃疝和小肠弹簧圈进入心包腔，并对相关文献进行了综述。
总结
一名49岁的土木工程师，有2年易疲劳和心悸病史以及6个月的高血压病史，最初作为扩张型心肌病病例进行治疗，以排除继发于高血压的早期CCF，经评估发现有慢性腹股沟疝通过中央腱，胃内容物取出，小肠弹簧圈进入心包腔。虽然在症状出现之前有机动车碰撞史，但长期的呼吸困难和心悸病史增加了后前胸X线片上增大的心脏轮廓，提出了诊断挑战，通过胸腹CT扫描解决了这一问题。患者行左侧后外侧胸廓切开术，经7小时肋间隙，在仔细粘连松解和双层修复缺损后，进行胃复位和小肠弹簧圈。
结论
高度怀疑的指数是非常重要的，考虑到损伤的罕见性和诊断的挑战，它构成了慢性形式的肌腱中央损伤的诊断。然而，在设备可用的情况下，CT扫描和二维超声心动图将在大多数情况下确定诊断;上消化道系列也是如此。
UNLABELLED
Traumatic diaphragmatic rupture through the central tendon with herniation of the stomach and coils of small bowel into the pericardial cavity.
METHOD
Case note of a patient managed for traumatic diaphragmatic rupture through the central tendon with herniation of the stomach and coils of small bowel into the pericardial cavity was used with a review of relevant literature.
SUMMARY
A 49-year old civil engineer who presented with 2-year history of easy fatigability and palpitations as well as a 6-month history of hypertension and was initially managed as a case dilated cardiomyopathy to rule out incipient CCF secondary to hypertension, was evaluated and found to have chronic diaphragmatic hernia through the central tendon with evisceration of the stomach and coils of the small bowel into the pericardial cavity. Though there was history of motor vehicle crash preceding the development of the symptoms, but the long history of effort dyspnoea and palpitations added to enlarged cardiac silhouette on posterior anterior chest x-ray, a diagnostic challenge was posed which was resolved by thoracoabdominal CT scan. Patient had left sided posteriorlateral thoracotomy via 7h intercostal space followed with reduction of thq stomach and coils of small bowel after careful adhesiolysis and repair of the defect in double layers.
CONCLUSION
High index of suspicion is very important in the diagnosis of diaphragmatic central tendon injury considering the rarity of the injury and diagnostic challenges it poses in chronic form. However, where the facilities are available, CT scan and 2-D echo will most of the time clinch the diagnosis; also is upper gastrointestinal series.