Chronic traumatic diaphragmatic hernia with pericardial rupture and associated gastroesophageal reflux
Chronic traumatic diaphragmatic hernia with pericardial rupture and associated gastroesophageal reflux
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慢性创伤性膈疝伴心包破裂及相关胃食管反流
作者：
B. Wright;T. Reinke;R. Aye
严重的胸部和腹部创伤有5%的时间会损伤横膈膜。这些损伤在发生时可能会被识别出来，但通常会在几个月后的相关症状检查中被发现。通常，损伤位于横膈膜的左后外侧。很少发生穿过中央肌腱进入心包腔的破裂，这导致与更常见的损伤不同的症状。我们提出的情况下，病人出现胸痛，近晕厥发作和难治性胃食管反流多年后，他被车撞到住院。影像学检查包括胸部CT，显示横结肠疝入纵隔。在探查过程中，发现中央隔膜缺损，腹膜和心包腔之间自由连通。在本文中，我们回顾我们的管理，这种不寻常的腹股沟疝和独特的症状与它有关。
Major thoracic and abdominal trauma damages the diaphragm 5% of the time. These injuries may be recognized when they occur but often are discovered months later during work up for related symptoms. Typically, the injury is to the left posterolateral aspect of the diaphragm. Rarely, rupture through the central diaphragmatic tendon into the pericardial space occurs and this results in different symptoms than the more common injury. We present the case of a patient who presented with chest pain, near syncopal episodes and refractory gastroesophageal reflux years after he was struck by a car and hospitalized. Radiographic imaging included a chest CT that demonstrated herniation of the transverse colon into the mediastinum. During exploration, a defect in the central diaphragm was found with free communication between the peritoneal and pericardial spaces. In this paper, we review our management of this unusual diaphragmatic hernia and the unique symptoms associated with it.