胸壁刺創後に発生し,肝を内容とした外傷性横隔膜ヘルニアの1例  [in Japanese] A CASE OF TRAUMATIC DIAPHRAGMATIC HERNIA INVOLVING THE LIVER OCCURRED AFTER RECEIVING A STABBED WOUND IN THE CHEST WALL  [in Japanese]

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Abstract

受傷後4年を経て発症し,肝左葉を内容の一部とした極めて稀な左側外傷性横隔膜ヘルニアの1例を経験したので報告する.症例は49歳,女性.平成2年12月,自殺企図で左前胸部刺傷し保存的に加療を受けた.平成6年9月上腹部痛,嘔吐を主訴に来院し胸部単純X線写真にて左胸水の貯留を認めた.上部消化管造影,胸部CT検査にて左胸腔内に胃体上部の脱出を認めた.既往と検査所見より外傷性横隔膜ヘルニアの診断で手術を行った.アプローチは開腹で,ヘルニア門は約4×4cm大で左横隔膜腱中心の左前方外側部に認められ胃体中部および肝左葉の一部が嵌入していた.脱出していた胃体部は色調良好であったが,肝臓は壊死を来しており切除し,ヘルニア門は一層縫合で閉鎖した.術後経過は良好である.

We experienced an extremely rare case of left-sided traumatic diaphragmatic herina involving the left hepatic lobe as a part of hernia content which occurred about 4 years after receiving a stabbed wound.<br> The case involved a 49-year-old woman. There was a previous history of receiving a stabbed wound in the anterior thoracic region for suicide purpose which was conservatively treated in December 1990. In September 1994 the patient was seen at the hospital because of an upper abdominal pain and vomiting. A simple chest X-ray film revealed pleural effusion. Upper gastrointestinal series and chest CT visualized a protrusion of the upper portion of the gastric body in the left thoracic cavity. Based on her previous history and results of examinations, she was operated on transabdominally under a diagnosis of traumatic diaphragmatic hernia. At laparotomy, the hernia opening was 4×4 cm in size; the hernia was located in the left anterior lateral portion of the central tendon of the diaphragm; and the middle portion of gastric body and a part of the left hepatic lobe were incarcerated. The protruded gastric body appeared good in color, but the liver necrosed and so the portion was excised. The hernia opening was closed in one layer suture. Postoperative course was uneventful.

Journal

  • The journal of the Japanese Practical Surgeon Society

    The journal of the Japanese Practical Surgeon Society 57(4), 881-884, 1996-04-25

    Japan Surgical Association

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