創傷性橫膈疝氣的延遲表現—個案報告

Delayed Presentation of Traumatic Diaphragmatic Hernia with Liver, Kidney and Intestines: A Case Report

創傷後橫膈疝氣是不常見但是嚴重的問題，常見於胸腹鈍傷或穿透性傷害之後。創傷性橫膈疝氣的診斷相當困難，重要的是需要保持警覺心。因為疝氣常在創 傷之後延遲才表現。我們在此報告一位 60 歲女性，在遭受跌倒撞傷 3 個月後發現橫膈疝氣。胸部 X 光顯示右側橫膈上升，電腦斷層影像顯示橫膈破裂併肝臟、右側腎 臟和小腸疝氣。從此個案可以了解，在曾有受傷病史的病患，延遲橫膈疝氣的診斷不應被遺忘。

 

Traumatic diaphragmatic hernia is an uncommon but severe problem usually seen in patients who suffered blunt abdomino-thoracic trauma or penetrating injuries. Blunt diaphragmatic hernia is difficult to diagnose and a high index of suspicion is vital. When there is late presentation, trauma can be forgotten and diaphragmatic injury can be omitted. We report a case of diaphragmatic hernia on the right side in a 60-year-old female who presented months after a fall injury. The liver and right kidney were herniated through the diaphragmatic tear. The chest X-ray revealed elevation of the right hemidiaphragm. CT showed a diaphragmatic hernia with herniation of the right kidney, small intestine and liver into the thorax. The diagnosis of late diaphragmatic hernia should always be considered in any patient with trauma history. This case also illustrates the rare possibility of herniation of the kidney and liver through a diaphragmatic tear.