• 한국임상수의학회지
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• 제31권6호
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• pp.531-534
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• 2014

3년령의 암컷 사냥견이 구토, 호흡곤란, 식욕부진을 주증으로 내원 하였다. 환자는 내원 2주 전 멧돼지에 받힌 병력이 있었다. 환자는 방사선사진상 횡격막 탈장 소견, 초음파 검사상 확장된 담도계가 확인되었다. 탐색적 개복술 시 오른쪽 횡격막의 손상이 확인되었고 흉강내에서 일부 간엽과 소장분절, 확장된 담도계를 확인하였다. 수술적 처치로 흉강내 위치하는 복강 장기들을 환원시키고 횡격막 탈장 교정술을 실시하였으며 이후 임상증상, 방사선사진과 초음파 검사 소견은 모두 정상적인 수준으로 회복되었다. 이를 토대로 횡격막 탈장에 의해 속발된 간외담도계폐색으로 진단하였다. 본 증례는 횡격막 탈장에 의해 속발된 간외담도계폐색이 발생한 증례 보고이다.

• Journal of Chest Surgery
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• 제7권2호
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• pp.163-168
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• 1974

Five cases of traumatic diaphragmatic hernia were repaired in the Department of Thoracic Surgery, Seoul National University Hospital, during the period from 1967 to 1974. The first case, a 14-year aid girl, was diagnosed as diaphragmatic hernia during laparotomy because of jejunal perforation 3 days after traffic accident. Herniated stomach, transverse colon, spleen and left lobe of the liver were repositioned and the diaphragmatic rupture on left posterolateral portion was repaired with two layers of nonabsorbable sutures by transthoracic approach. The second case, a 26-year old man,was diagnosed immediately after traffic accident at a local clinic and transferred to this hospital 24 hours later. Herniated stomach, transverse colon and jejunum were repositioned amd diaphragmatic rupture,about 9 cm in length,from the posterolat.edge to the base of pericardium was sutured in two layers. The third case, a 26-year old man who had stab wound on the left lower lateral chest two years ago,was admitted with sudden abdominal pain and vomiting. Upper gastrointestinal series with barium meal revealed diaphragmatic hernia. The herniated stomach and transverse colon through the defect,about 3.5cm in diameter, at anterolateral portion on the left side,were repositioned and repaired with two layers of nonabsorbable sutures. The forth case, a 26-year old man, sustained blunt trauma to the chest by a roller and was transferred to the emergency room complaining of dyspnea 40 minutes after the accident. The diaphragmatic rupture extended from left midaxillary line to contralateral anterior axillary line,about 20cm long, at anterior portion of diaphragm, which was repaired with two layers, of nonabsorbable sutures. The fifth case, a 4-year old girl, had two separate diaphragmatic ruptures on both sides, which were caused by traffic accident. Immediate upper gastrointestinal series after injury showed herniated stomach, colon and spleen into left Chest cavity. Another small rupture with anterior edge of right lobe of the liver in chest cavity was noted. These were repaired with non-absorbable sutures via thoracotomy.

• Journal of Chest Surgery
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• 제55권1호
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• pp.85-87
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• 2022

Diaphragmatic hernias have been reported in 0.8%-1.6% of patients who experience blunt chest trauma. The hernia is assumed to form as a result of direct diaphragmatic violation or significant intraabdominal or intrathoracic pressure caused by the trauma. Some reports have described cases of delayed diaphragmatic hernia and subsequent stomach perforation that occurred a few days to several years after an accident. We report an extremely rare case of diaphragmatic herniation in which the process from initial blunt trauma to visceral organ perforation took only 2 days, without any evidence of herniation on the initial X-ray or computed tomography. Delayed diaphragmatic herniation and subsequent visceral organ perforation should not be missed during the period immediately after blunt chest trauma.

• Journal of Chest Surgery
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• 제31권2호
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• pp.162-167
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• 1998

저자들은 1976년 1월 부터 1997년 3월 까지 21년간 외상성 횡격막 파열 52례 중 지연성 외상성 횡격막 탈장 6례를 치험 하였는데 이중 남자는 4례, 여자는 2례였으며 우측은 1례였다. 둔상에 의한 경우는 5례였고 자상은 1례였다. 수술은 모두 개흉술을 시행 하였고 복부로 절개를 연장한 경우가 1례 있었다. 외상성 흉부 손상을 입었을 때 횡격막 파열을 의심하는 것이 중요하며 흉강경을 이용하여 진단및 치료를 할 수 있다.

• Journal of Chest Surgery
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• 제20권4호
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• pp.839-846
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• 1987

The records of 10 patients with traumatic diaphragmatic hernia seen from November 1977 through July 1987 were reviewed. All the patients had a transdiaphragmatic evisceration of abdominal contents into the thorax. We treated 7 male and 3 female patients ranging in age from 3 to 62 years. In 8 patients, diaphragmatic hernia followed blunt trauma and in 2 patients, stab wounds to the chest. The herniation occurred on the right side in 3 patients and on the left side in 7. All the patients sustained additional injuries: rib fractures [7 patients], additional limb, pelvic and vertebral fractures [6], closed head injury [2], lung laceration [1], liver laceration [1], renal contusion [1], ureteral rupture [1], and splenic rupture [1]. Organs herniated through the diaphragmatic rent included the omentum [6 patients], stomach [4], liver [4], colon [3], small intestine [1], and spleen [1]. For right-sided injuries, the liver was herniated in all 3 patients and the colon, in 1. in the initial or latent phase, dyspnea, diminished breath sounds, bowel sounds in the chest were noted in 4 patients, and in the obstructive phase, nausea, vomiting, and abdominal pain were found in all 3 patients. Two patients had a diagnostic chest radiograph with findings of bowel gas patterns, and an additional 8 had abnormal but nondiagnostic studies. Hemothorax, pleural effusion or abnormal diaphragmatic contour were common abnormal findings. Three patients were operated on during the initial or acute phase [immediately after injury], 4 patients were operated on during the latent or intermediate phase [3 to 210 days], and 3 patients were operated on during the obstructive phase [10 to 290 days]. Six patients underwent thoracotomy, 2 required thoracoabdominal incision, and 2 had combined thoracotomy and laparotomy. Primary suture was used to repair the diaphragmatic hernia in 9 cases. One patient required plastic repair by a Teflon felt. Empyema was the main complication in 2 patients. In 1 patient, the empyema was treated by closed thoracostomy and in 1, by decortication and open drainage. There were no deaths.

• Journal of Chest Surgery
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• 제8권1호
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• pp.45-50
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• 1975

Eleven cases of traumatic diaphragmatic hernia treated at the department of thoracic and cardiovascular surgery, for the period of seven years up to February 1975, from the base of this report. 1. Peak incidence was found in the age group of one to four years and thirty to forty years, four cases in each group respectively, occupying 63.6% of all cases. 2. In all the lesions the left diaphragm was affected and the herniated organs were in order of frequency the small bowel, the large intestine, the stomach, and the spleen. 3. The methods of the adapted treatment were laparatomy in five, thoracoabdominal approach in four, and thoracotomy in two cases. 4. The mortality rate was low, only one out of eleven died It seems that the immediate appropriate treatment can bring forth the excellent outcome.

• 대한수의학회지
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• 제49권4호
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• pp.351-354
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• 2009

Diaphragmatic hernias, whether congenital or acquired (traumatic), are rarely observed in the horse. Acquired diaphragmatic hernias typically occur secondary to trauma or an increase in intraabdominal pressure due to falling, heavy exercise, or parturition. Diaphragmatic herniorrhaphy is difficult to perform in adult horses and the horses with symptomatic diaphragmatic hernias usually die. A 10- year old, 340 kg, Jeju horse (crossbred) broodmare with sudden onset of gait disorder and a moderate emaciation was examined. Findings on physical examination included conjunctivitis, dehydration, shallow breathing, dyspnea, weaken heart beat, lack of auscultatable sounds from the gastrointestinal tract, and anorexia. Rectal temperature was $38.4^{\circ}C$ and respiratory rates were moderately increased. There were slight signs of acute colic. The broodmare died one day after non-specific treatment of fluids, nutriment, antibiotics and non-steroidal anti-inflammatory drug. The cause of death was strangulation of the small intestine through a diaphragmatic hernia. The rent was about 2 cm in diameter and located in the central right part of diaphragm. Around 60 cm of small intestine was protruded into thoracic cavity through the rent. The cause of the hernia could not be ascertained. The broodmare had been pastured with many other horses, and the groom had not noticed any aggressive behavior among them. It was, however, speculated that trauma by stallion's attack may have been the cause of the diaphragmatic hernia, because the new horse may be the object of behaviors ranging from mild threats to seriously aggressive kicking, squealing, rearing, and biting.

• Journal of Trauma and Injury
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• 제27권2호
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• pp.38-42
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• 2014

Traumatic diaphragmatic rupture is quite uncommon and rarely lethal injury. However, delayed presentation between the injury and the diagnosis can cause a life-threatening condition with various complications such as intestinal hernia, obstruction, strangulation, respiratory distress. Here, we present a case of delayed presentation of traumatic diaphragmatic rupture in a 51-year-old man, and then discuss about the clinical implication of delayed presentation of diaphragmatic rupture with a review.

• Journal of Trauma and Injury
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• 제35권1호
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• pp.61-65
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• 2022

Traumatic abdominal wall hernia is a very rare clinical entity. Herein, we report the case of a patient who was transferred from a local clinic to the emergency department because of left lower abdominal pain. Initially, an intra-abdominal hematoma was observed on computed tomography and no extravasation was noted. Conservative treatment was initiated, and the patient's symptoms were slightly relieved. However, though abdominal pain was relieved during the hospital stay, bowel herniation was suspected in the left periumbilical area. Follow-up computed tomography showed traumatic abdominal wall hernia with hemoperitoneum in the abdomen. We performed a laparoscopic exploration of the injury site and hernia lesion. The anterior abdominal wall hernia was successfully closed.

• Journal of Trauma and Injury
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• 제32권4호
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• pp.210-219
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• 2019

Purpose: Traumatic diaphragmatic injury (TDI) is no longer considered to be a rare condition in Korea. This study investigated differences in the prevalence of accompanying injuries and the prognosis in patients with traumatic diaphragmatic damage according to the mechanism of injury. Methods: We retrospectively reviewed the medical records of patients with TDI who were seen at a regional emergency medical center from January 2000 to December 2018. Among severe trauma patients with traumatic diaphragmatic damage, adults older than 18 years of age with a known mechanism of injury were included in this study. Surgery performed within 6 hours after the injury was sustained was defined as emergency surgery. We assessed the survival rate and likelihood of respiratory compromise according to the mechanism of injury. Results: In total, 103 patients were analyzed. The patients were categorized according to whether they had experienced a penetrating injury or a blunt injury. Thirty-five patients had sustained a penetrating injury, and traffic accidents were the most common cause of blunt injuries. The location of the injury did not show a statistically significant difference between these groups. Severity of TDI was more common in the blunt injury group than in the penetrating injury group, and was also more likely in patients with respiratory compromise. However, sex, the extent of damage, and the initial Glasgow coma scale score had no significant relationship with severity. Conclusions: Based on the findings of this study, TDI should be recognized and managed proactively in patients with blunt injury and/or respiratory compromise. Early recognition and implementation of an appropriate management strategy would improve patients' prognosis. Multi-center, prospective studies are needed in the future.