Foreign body ingestion causing gastric and diaphragmatic perforation in a child

Foreign body ingestion is a common problem in children. Most ingested foreign bodies pass through the gastrointestinal tract without difficulty once they reach the stomach. Perforation of the gastrointestinal tract very rarely occurs. This case report discusses the clinical presentation and management of a very unusual case of an eyeliner pencil ingested by a child that perforated the stomach and diaphragm, causing empyema.     

Delayed traumatic diaphragmatic hernias presenting with strangulation

Traumatic diaphragmatic injuries commonly occur following blunt and penetrating trauma, and that may be missed during a first evaluation, resulting in chronic diaphragmatic hernia and/or strangulation. In this study, we present three cases of delayed traumatic diaphragmatic hernias presenting with strangulation. The type of trauma was blunt in two and penetrating in one patient. In all three cases, the diagnoses of diaphragmatic injuries were missed in acute and chronic settings. While two patients had transverse colonic strangulation, the other one had strangulated stomach and spleen. Transverse colon resection was performed in one patient. Two patients had postoperative complications, and no postoperative mortality was detected. Patients complaining of upper abdominal pain and dyspnea with past history of thoracoabdominal trauma should be evaluated for a missed diaphragmatic injury. A high index of suspicion, physical examination of the chest, and x-ray film are helpful for diagnosis of delayed traumatic diaphragmatic hernias presenting with strangulation.     

Diaphragmatic hernia resulting from injury during microwave-assisted laparoscopic hepatectomy

A 31-year-old woman underwent microwave-assisted laparoscopic hepatectomy of the left lateral segment for focal nodular hyperplasia on January 14, 1998. On September 9, 1998, she felt continuous left abdominal pain and was admitted to our hospital for further examination. An upper gastrointestinal series showed converging folds of the greater curvature of the upper third of the stomach and craniad displacement of this portion. Thoracic magnetic resonance imaging showed herniation of the stomach into the pleural cavity. The patient was referred to our department, where she underwent surgery for a diaphragmatic hernia. The fundus of the stomach had escaped into the left pleural cavity through a defect in the diaphragm near where laparoscopic hepatectomy had been performed. The stomach was returned to the peritoneal cavity and the defect sutured. The patients postoperative course was uneventful. Although diaphragmatic hernia after laparoscopic surgery is a rare complication, with the performance of more advanced laparoscopic procedures and the use of higher-technology tissue-destruction/hemostatic devices such as the microwave coagulator, more caution should be observed to prevent injury to adjacent organs such as the diaphragm.     

Diagnosis and Surgical Treatment of Morgagni Hernia: Report of Three Cases

Morgagni hernia is a rare congenital disorder, which is usually asymptomatic, but may cause respiratory or gastrointestinal symptoms. We reviewed the clinical findings of three patients with a Morgagni hernia, diagnosed and treated in our department between 1997 and 2000. The Morgagni hernia caused various symptoms in all three patients and surgery was performed via posterolateral thoracotomy in two, and via laparatomy in one. The hernial defect was closed by primary suturing in two patients and by synthetic mesh in one. All three patients had an uneventful postoperative recovery. We believe that the transthoracic approach is an effective way of repairing Morgagni hernia. Received: October 19, 2001 / Accepted: July 2, 2002 RID="*" ID="*" Reprint requests to: I.C. Kurkcuoglu, Ataturk Universitesi Tip Fakultesi, Gogus Cerrahisi ABD, 25240 Erzurum, Turkey     

Incarcerated diaphragmatic hernia secondary to plication for eventration of diaphragm

Diaphragmatic plication is the procedure of choice for congenital diaphragmatic eventration. In the absence of complications, most newborns with eventration do well after plication and have normal long-term respiratory functions. However complications are rare. Recurrence, ipsilateral pneumothorax and rupture of the diaphragm have been reported in literature. We report a case of incarcerated diaphragmatic hernia in a two-yearold child who had undergone plication for eventration of the diaphragm at six months of age     

Diaphragmatic hernia in a female newborn with focal dermal hypoplasia and marked asymmetric malformations (Goltz-Gorlin Syndrome)

We report a female newborn with focal dermal hypoplasia (Goltz-Gorlin Syndrome) and marked asymmetric malformations on the right side of the body. Diaphragmatic hernia on the same side, which has not been reported in this syndrome, led to perinatal complications.     

先天性婴幼儿膈膨出的诊断和治疗

目的 探讨先天性婴幼儿膈膨出的病因、临床特点、诊断及治疗方法。方法 对近１０年来收治的１２例先天性婴幼儿膈膨出进行回顾性分析。结果 本组１２例中，行膈肌折叠手术治疗８例，３例为右侧因膨出程度及症状较轻而未手术，１例因合并多发畸形放弃治疗，术后死亡１例，其余效果良好。结论 先天性婴幼儿膈膨出病因不明确，可能与遗传、胎儿宫内感染以及药物有关，低体重和反复呼吸道感染是该症的主要临床特征。早期诊断和手术治     

Zum Faserverlauf im Centrum tendineum

Zusammenfassung Bei einem Polytrauma besteht immer die Möglichkeit einer Zwerchfellruptur. Vorwiegend erfolgt die Ruptur im Centrum tendineum. Ein Grunt für die bizarre Form der Rupturen sind die in individueller Abstufung auftretenden Lücken zwischen den Sehnenbündeln; these Bündel lassen sich in 3 Gruppen einteilen. Bei Rupturen ist meist der linke Seitenteil betroffen. Neben der schültzenden Wirkung der Leber ist ein weiterer Grund für das relativ geringe Auftreten rechtsseitiger Rupturen die größere Stabilität des rechten Seitenteils durch eine stärkere Verflechtung der Sehnenfasern. Die Zwerchfellruptur bei Polytraumatisierten wird häufig übersehen, ihre Zahl könnte jedoch bei gezielter Diagnostik deutlich gesenkt werden. Eine operative Versorgung der Zwerchfellruptur macht im allgemeinen keine Schwierigkeiten, ein abdominales Vorgehen ist zu favorisieren. Die Gesamtprognose hängt von Art und Schwere der Begleitverletzungen ab.

---

The course of fibres in the central tendon

Summary In each polytrauma a diaphragmatic rupture is possible. Usually the rupture is located in the central tendon. A cause of the bizarre form of ruptures is the individual arrangement of gaps between the fibres of the central tendon. These fibres are classified in three groups. A rupture is generally on the left side of the central tendon. A further cause of the relative rare rupture on the right side is beside protection by the liver the greater stability on the right side of the central tendon, because fibres are more interlocked. The diaphragmatic rupture of a polytrauma is often overlooked, this number could be reduced by specific diagnostics. The repair of a diaphragmatic rupture is not a problem, an abdominal approach should be preferred. The prognosis depends on extension of concomitant lesions.

     

鞍区硬膜结构相关的临床解剖研究

目的 研究鞍区硬膜结构的显微解剖及其手术意义。方法 观测尸颅鞍区硬膜结构的显微解剖特征。结果 床突间皱襞将海绵窦顶分为两个三角，少数鞍隔向内下倾斜成盆状，动眼神经硬膜孔大致位于后床突水平。隔孔区的垂体腺由二层组织覆盖，上层是蛛网膜，下是更薄的膜样结构，少数蛛网膜层以脂肪垫形式填塞于鞍隔与垂体腺之间，仅见一例垂体池。结论 隔孔大者垂体容易下陷，蛛网膜坠入鞍隔下方与隔孔较大有关，垂体池是形成空蝶鞍的潜在因素。国人鞍隔屏障性能差，经蝶手术后容易脑脊液漏。     

创伤性膈疝的诊断与治疗

目的 总结创伤性膈疝的诊断和治疗经验。方法 分析27例创伤性膈疝患者受伤的原因，入院时的主要症状，体征，合并伤，信要检查资料及手术时机，死亡原因，钝性伤13例。锐器穿透伤14例；左膈疝25例，右膈疝2例；经腹手术14例，经腹手术13例。结果 22例（81.5%)术后痊愈，5例死亡。死亡率18.5%。结论 胸腹部创伤患者应警惕膈肌的损伤，创伤性膈疝的表现常被合并伤的表现所掩盖，要注意受伤的原因，体位及外力作用的方向。认真的胸部X线电视透视是最可靠的检查方法。创伤性膈疝一经发现，应尽快给予手术治疗。