兒童外傷性右側橫隔膜破裂病例報告

Traumatic Rupture of the Right Diaphragm in a Child: Case Report

外傷性橫隔膜破裂在鈍挫性傷害中有增加的趨勢，同時，也是常被討論到的一個題目。儘管我們對這一類傷害的瞭解日益增加，但由於這一類傷患常合併有其它的傷害，與及沒有特殊的臨床症狀，再加上肺部的傷害常影響到放射線攝影的判讀，因此、外傷性橫隔膜破裂在手術前的正確診斷並不容易。右側橫隔膜因有肝臟的阻擋作用，故於外傷破裂時，腹部內臟器不會立刻進入胸腔使得診斷上更為困難。這種不易診斷或誤診的情況較常發生在小孩身上。本文將報告發生於一位小孩的外傷性右側橫隔膜破裂，並回顧以往所有有關文獻。

TRAUMATIC RUPTURE of the diaphragm has been an increasingly recognized injury and a popular topic of debate in the discussion of blunt trauma. Despite the advances in our understanding of the injury, the preoperative diagnosis of diaphragmatic rupture caused by blunt injury is often difficult to make because of serious con-current injury, a lack of specific clinical signs, and the presence of coexisting lung disease that may mask or mimic the radiological features suspicious of diaphragmatic rupture. Right hemidiaphragmatic rupture is particularly difficult to detect because it produces less immediate herniation of the abdominal viscera due to the plugging effect of liver into the defect. The diagnosis of this condition is even more difficult in the pediatric population wherein the type of injury is less prevalent and the possibility of diaphragmatic rupture maybe less often considered. We herein describe the clinical course of a case of diaphragmatic rupture in a child.