慢性间歇期创伤性膈疝1例报告

患者　女 ,42岁。 1月前无明显诱因出现进食后腹部胀满、不适 ,严重时感腹痛明显 ,呈阵发性加重 ,伴恶心、呕吐 ,吐后不适稍感减轻。 1年前患者曾被人刺伤胸部 ,在外院行胸腔闭式引流术。体检 :左下肺呼吸音减低 ,腹平软 ,无压痛及反跳痛 ,患侧胸背部见纵形刀伤瘢痕 ,长约 5ｃｍ。胸部透视 :左下胸部呈大片密度增高影 ,上界为凸向上方的弧形线影 ,其内可见气液平面 ,左肋膈角变钝 ,左侧胸膜肥厚粘连。诊断 :考虑左侧液气胸 ,建议钡餐检查 ,排除左侧创伤性隔疝。胃肠钡餐造影检查 :立位服钡后 ,食道钡剂通过顺利 ,食管胃角明显增大 ,钡剂滞留…     

64层螺旋CT多平面重组诊断创伤性膈疝1例

患者男性,65岁。汶川特大地震泥石流砸埋伤致全身多处疼痛及左下肢不能站立2天。2天前,患者在地震时被泥石流砸埋,3小时后被救出,感全身多处疼痛,尤以左前胸及右后背为重,咳嗽及吸气时加重,无昏迷,无气促。查体：全身多处擦伤,皮下淤血,无开放性伤口,左大腿肿胀畸形,胸廓对称无畸形,胸廓挤压征阳性。     

创伤性膈疝4例

本院近几年收冶外伤性膈疝4例，均经X线诊断．手术证实现报告如下。     

陈旧性创伤性膈疝2例

患者 1男性,41岁.主诉:1天前饭后体力劳动后出现上腹部隐痛,疼痛为阵发性,轻微腹胀,胸闷气促症状,自诉30余年曾有胸腹外伤史,3年前曾出现上腹部隐痛未诊治,1年前某医院体检诊断右膈疝,保守治疗后出院.手术所见:术中见右侧膈肌完全破裂,并有约20cm×25cm大小约缺损,肝脏全部、胆囊、部分升结肠、结肠肝曲、部分小肠及系膜组织破入胸腔,至右侧胸膜顶部,压迫右肺,右肺不张,纵隔左偏,肝脏发育畸形,质地偏硬,表面不光滑,整个肝脏向上向外翻转,胆囊窝紧贴右外侧胸壁,肠管及系膜嵌顿于膈肌破裂口,不能回纳,肠管壁充血、水肿明显,色泽呈暗红色,血供较好,右肺肺裂发育较好,鼓肺后复张良好,膈肌破裂后外侧边缘与肝脏包膜延续无明显分界,肝脏部分固定,不能完全回纳入腹腔.     

13例创伤性膈疝的X线诊断

1　ａ)左下肺大片的致密影 ,内可见多发大小不一囊状透亮影 ,左膈面消失 (→ ) ;ｂ)胃、小肠及结肠疝入胸腔内 (→ )。图 2　ａ)左下肺巨大含气囊腔 ,内见液平 (→ ) ,左下肺野见片状致密影 (→ ) ;ｂ)吞钡见胃形态异常 ,胃体反折 ,胃内含大量气体及液体 ,胃大部疝入胸腔内。图 3　ａ)右膈肌抬高 ,肝影上移 ;ｂ)ＣＴ示肝脏上移 ,后方少量胸腔积液 (→ )。材料与方法我院 13例创伤性膈疝均经手术或典型病史及影像学表现证实 ,其中男 10例 ,女 3例 ,年龄 15～ 74岁 ,平均 2 8.9岁 ,均有外伤史。闭合性创伤 10例 ,开放性创伤 3例 ,病程最长者达…     

膈疝的CT诊断价值(附15例分析)

目的：探讨膈疝的CT诊断及其临床手术指导价值。方法：通过以横膈部位为中心行胸腹部螺旋CT扫描，获得理想的CT扫描图像，通过15例膈疝患者的扫描图像，结合临床综合分析。结果：膈上有疝囊15例，囊内有液平面13例，有小肠及结肠肠型的1例，有脂肪组织1例，胸腔内有积液2例。结论：CT检查对膈疝的诊断应当作为首选的检查方法，其不仅能对膈疝做出正确的诊断，而且，对临床手术指导具有重要的临床治疗意义。     

多层螺旋CT在创伤性膈疝诊断中的应用

目的 探讨多层螺旋CT多平面重组图像在创伤性膈疝诊断中的应用.方法 回顾性分析10例经手术证实的创伤性膈疝的多层螺旋CT表现,重点分析多平面重组图像特点.10例患者术前均行胸部正位片及多层螺旋CT检查.结果 8例X线有阳性发现,提示创伤性膈疝;而10例患者经多层螺旋CT多平面重组图像后矢状位、冠状位清晰可见膈肌连续性中断,并清晰显示裂口的位置、裂口的大小及疝入胸腔的内容物.全部病例均经手术治疗并痊愈.结论 多层螺旋CT多平面重组图像在创伤性膈疝中有重要价值,确诊后均应及时手术治疗.     

迟发型创伤性膈疝12例

胸腹部创伤所致的膈肌损伤 ,有相当一部分病例急性期无膈肌破裂表现 ,而在后期出现迟发型膈疝[1] ,其临床表现多样化 ,预后可凶险 ,给临床诊治带来一定困难。笔者报告 1989年 1月～ 1999年 12月共 12例迟发型创伤性膈疝 ,探讨其诊断和治疗。临　床　资　料1.一般资料 :本组共 12例 ,男 9例 ,女 3例 ;年龄 17～ 45岁 ,平均 32 .5岁。腹部钝性伤 5例 ,其中交通伤 2例 ,高处坠落伤 3例。钝性伤中有 1例行急诊腹腔探查脾切除术。左季肋部刀刺伤 7例 ,其中 6例伤后早期行急诊清创缝合术 ,1例行腹腔探查脾切除 空肠穿孔修补术。症状出现时间距原…     

创伤性膈疝的影像分析

目的：分析创伤性膈疝的X线，CT表现及其诊断意义。材料和方法：回顾性分析精选9例创伤性膈疝患者及相关材料。结论：胸部创伤，是外科急诊中较常见病例，由于车祸、碰撞、打击、挤压、刺伤均可导致严重胸部复合性创伤，而外伤性膈疝，皆在此基础上，同时合并。行X线、CT检查时应注意与其它外伤性胸部创伤病变鉴别，为外科手术提供可靠的诊断依据。     

CT demonstration of traumatic ventral hernia and diaphragmatic rupture. A case report

Traumatic ventral hernias occur rarely. A case is presented where bowel has herniated through a traumatic defect of the anterior abdominal musculature, demonstrated by CT. This has not been previously reported in the literature. These loops of bowel showed mural thickening and high density indicating severe injury and were found at laparotomy to be ischaemic. The patient simultaneously suffered rupture of the right hemidiaphragm, also demonstrated by CT and also an uncommon injury.     

Chronic traumatic diaphragmatic hernia: the significance of pleural effusion

Five patients with chronic traumatic diaphragmatic hernia presented with symptoms of acute intestinal obstruction and unilateral pleural effusion. In each case, infarcted herniated abdominal structures were found at surgery. The presence of an ipsilateral pleural effusion is an important radiographic sign, which may indicate strangulation in patients with chronic traumatic diaphragmatic hernia.     

创伤性窒息、血气胸并发创伤性膈疝1例

创伤性膈疝常并发其他器官损伤,因病情危重,而膈疝症状不典型,故救治过程中常易漏诊。创伤性膈疝一旦误诊、漏诊,其预后较差,死亡率亦较高,高度怀疑膈疝时应进行针对性检查,以便及时诊治,提高救治成功率。     

Late presentation of congenital diaphragmatic hernia (CDH): A rare case report

Reporting a rare case of a 17-year-old lady with late presentation of congenital diaphragmatic hernia. She presented with vague abdominal pain and postprandial vomiting. She underwent a diagnostic upper GI scopy with no significant findings. Chest X-ray and barium study for stomach were performed. Then CT scan was performed and showed herniation of bowel loops, mesentery and spleen into the left thoracic cavity through a large defect in the posterolateral aspect of the left hemidiaphgram. After the patient was operated, content reduced and defect was repaired. Thus CDH in adolescence is rare and a high index of suspicion is required.     

Delayed presentation of traumatic diaphragmatic hernia

Nine cases of delayed presentation of diaphragmatic hernia secondary to blunt trauma are presented. The delay in presentation varied from one to 16 years from the time of the original injury. The chest radiography was abnormal in all cases. In some, herniation could be reasonably inferred but in others there were only non-specific signs. Once the diagnosis of delayed presentation of traumatic diaphragmatic hernia is suspected, we have found barium studies to be the most useful confirmatory investigations.     

Diagnosis of posterolateral congenital diaphragmatic (Bochdalek) hernia by liver scintigram: case report.

A characteristic liver scintigraphic finding was observed in a 2-month-old infant with hepatic herniation through a right-sided posterolateral congenital diaphragmatic defect (Bochdalek). The liver scintigrams showed an oblique band of decreased radioactivity dividing the liver into an inferior anteromedial portion and a superior posterolateral portion. In spite of the markedly abnormal liver scintigram, other diagnostic studies, including pneumoperitoneum abdominal radiography, remained negative. The liver scintigram can provide life-saving information in the diagnosis of congenital diaphragmatic hernia, as in the present case. The distinctive liver-scan findings among the various types of common diaphragmatic hernias are also briefly reviewed.     

急性创伤性膈疝影像学诊断

目的 探讨急性创伤性膈疝的影像学表现及诊断价值。材料与方法24例均行胸腹透视、拍胸部平片,其中10例做胃肠道造影检查,8例行CT扫描,对X线征象及CT表现进行对比分析。结果X线表现为膈上胃泡影11例,多个液气平面6例,膈上肿块5例,漏诊2例。CT发现膈上疝囊5例,膈上肿块2例,漏诊1例。结论多种影像学检查方法综合应用能提高创伤性膈疝的诊断率。