Post-traumatic diaphragmatic hernias: diagnostic difficulties, treatment (clinical observations)

封面

如何引用文章

全文:

开放存取 开放存取
受限制的访问 ##reader.subscriptionAccessGranted##
受限制的访问 订阅或者付费存取

详细

An increase in the number of cases of combined and multiple injury among the population leads to an increase in the prevalence of the diaphragm damage. At the same time, developing shock states and prevailing damage to the breast and abdomen, as well as the absence of specific clinical symptoms make it difficult to detect damage to the diaphragm, which leads to medical diagnostic errors and complications. The article discusses clinical cases of successful surgical treatment of patients with post-traumatic false hernias of the diaphragm.

全文:

受限制的访问

作者简介

S. Yurov

I.S. Berzon Krasnoyarsk Interdistrict Clinical Hospital No. 20

编辑信件的主要联系方式.
Email: sergey.yurov.1978@mail.ru
俄罗斯联邦, Krasnoyarsk

D. Cherdantsev

Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia

Email: sergey.yurov.1978@mail.ru
ORCID iD: 0000-0002-4743-4565
SPIN 代码: 6760-3354

Professor, MD

俄罗斯联邦, Krasnoyarsk

A. Dudarev

Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia

Email: sergey.yurov.1978@mail.ru
SPIN 代码: 4141-3701
俄罗斯联邦, Krasnoyarsk

Yu. Trofimovich

Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia

Email: sergey.yurov.1978@mail.ru
ORCID iD: 0000-0001-9956-9771
SPIN 代码: 3347-1827
俄罗斯联邦, Krasnoyarsk

O. Pervova

Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia

Email: sergey.yurov.1978@mail.ru
ORCID iD: 0000-0002-2797-1611
SPIN 代码: 6689-6490

Professor, MD

俄罗斯联邦, Krasnoyarsk

V. Kovrigin

I.S. Berzon Krasnoyarsk Interdistrict Clinical Hospital No. 20

Email: sergey.yurov.1978@mail.ru
俄罗斯联邦, Krasnoyarsk

M. Baeva

Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia

Email: sergey.yurov.1978@mail.ru
俄罗斯联邦, Krasnoyarsk

A. Makarchuk

Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia

Email: sergey.yurov.1978@mail.ru
俄罗斯联邦, Krasnoyarsk

A. Saverchenko

I.S. Berzon Krasnoyarsk Interdistrict Clinical Hospital No. 20

Email: sergey.yurov.1978@mail.ru
俄罗斯联邦, Krasnoyarsk

参考

  1. Демко А.Е., Вербицкий В.Г., Осипов А.В. и др. Лечение пациента с ущемленной посттравматической гигантской левосторонней диафрагмальной грыжей. Вестник Дагестанской государственной медицинской академии. 2023; 1 (46): 54–8 [Demko A.E., Verbitsky V.G., Osipov A.V. et al. Treatment of a patient with strengthened posttraumatic giant left-sided diaphragmic herniation. Bulletin of the Dagestan State Medical Academy. 2023; 1 (46): 54–8 (in Russ.)].
  2. Ладутько И.М., Хрыщанович В.Я., Домаренок Е.П. и др. Диагностика и лечение ущемленных диафрагмальных грыж. Хирургия. Восточная Европа. 2021; 10 (1): 66–77 [Ladutko I.M., Khryshchanovich V.Ya., Domarenok E.P. et al. Diagnostics and treatment of strangulated diaphragmatic hernias. Surgery. East Europe. 2021; 10 (1): 66-77. (in Russ.)]. doi: 10.34883/PI.2021.10.1.015
  3. Корымасов Е.А., Погодина А.Н., Пищик В.Г. и др. Клинические рекомендации «Дефекты и повреждения диафрагмы. Посттравматические диафрагмальные грыжи», 2015. [Korymasov E.A., Pogodina A.N., Pishik V.G., et al. Clinical recommendations "Defects and damage to the diaphragm. Posttraumatic diaphragmatic hernias", 2015 (in Russ.)].
  4. Маслов В.И., Тахтамыш М.А. Хирургическая тактика при осложненных травматических диафрагмальных грыжах. Хирургия. 2004; 7: 26–31 [Maslov V.I., Takhtamysh M.A. Surgical tactics in complicated traumatic diaphragmatic hernias. Surgery. 2004; 7: 26–31 (in Russ.)].
  5. Юров С.В., Серова Е.В., Винник Ю.С. и др. Диагностика и лечение при осложненных травматических грыжах. Врач. 2018; 29 (7): 48–50 [Yurov S., Serova E., Vinnik Yu. et al. Post-traumatic diaphragmatic hernias: diagnosis and treatment. Vrach. 2018; 29 (7): 48–50 (in Russ.)]. doi: 10.29296/25877305-2018-07-10
  6. Porojan V.A., David O.I., Coman I.S. et al. Traumatic Diaphragmatic Lesions – Considerations Over a Series of 15 Consecutive Cases. Chirurgia (Bucur). 2019; 114 (1): 73–82. doi: 10.21614/chirurgia.114.1.73
  7. Elkbuli A., Meneses E., Shepherd A. et al. Traumatic diaphragmatic rupture successfully managed in 4-year-old patient: Case report and literature review. Int J Surg Case Rep. 2020; 72: 237–40. doi: 10.1016/j.ijscr.2020.06.026
  8. Тулупов А.Н., Синенченко Г.И. Торакоабдоминальная травма. СПб: Фолиант, 2015 [8. Tulupov A.N., Sinenchenko G.I. Thoracoabdominal trauma. St. Petersburg: Foliant, 2015 (in Russ.)].
  9. Трофимова Е.Ю., Богницкая Т.В., Мажорова И.И. и др. Выявление разрыва диафрагмы при ультразвуковом исследовании у пациентов с закрытой травмой груди и живота. Ультразвуковая и функциональная диагностика. 2014; 2: 75–81 [Trofimova E.Yu., Bognitskaya T.V., Mazhorova I.I. et al. Diaphragmatic rapture ultrasound diagnostics in patients with blunt trauma of chest and abdomen. Ultrasound and Functional Diagnostics. 2014; 2: 75–81 (in Russ.)].
  10. Лосик Е.А., Фадеева М.В., Щегельский В.В. и др. Бессимптомный посттравматический разрыв правого купола диафрагмы. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2018; 28 (4): 102–9 [Losik E.A., Fadeeva M.V., Shchegelsky V.V. et al. Asymptomatic Post-Traumatic Rupture of the Right Diaphragm Dome. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2018; 28 (4): 102–9 (in Russ.)]. doi: 10.22416/1382-4376-2018-28-4-102-109
  11. Звездкина Е.А., Лесняк В.Н., Белов М.А. и др. Возможности спиральной компьютерной томографии в диагностике повреждений диафрагмы и их последствий. Клиническая практика. 2014; 1: 31–7 [Zvezdkina E.A., Lesnyak V.N., Belov M.A. et al. Facilities of helical CT in diagnostic of diaphragmatic injuries and its consequences. Journal of Clinical Practice. 2014; 1: 31–7 (in Russ.)].
  12. Овчинников П.Д., Андреев А.И., Большаков Д.В. и др. Редкий случай закрытой травмы грудной клетки, осложненный разрывом диафрагмы. Практическая медицина. 2016; 5 (97): 121–3 [Ovchinnikov P.D., Andreev A.I., Bolshakov D.V. et al. A rare case of closed chest trauma, complicated by rupture of the diaphragm. Practical medicine. 2016; 5 (97): 121–3 (in Russ.)].
  13. Mahamid A., Peleg K., Givon A. et al. Blunt traumatic diaphragmatic injury: A diagnostic enigma with potential surgical pitfalls. Am J Emerg Med. 2017; 35 (2): 214–7. doi: 10.1016/j.ajem.2016.10.046
  14. Gmachowska A., Pacho R., Anysz-Grodzicka A. et al. The Role of Computed Tomography in the Diagnostics of Diaphragmatic Injury After Blunt Thoraco-Abdominal Trauma. Pol J Radiol. 2016; 81: 522–8. doi: 10.12659/PJR.897866
  15. Маланов С.В., Петров М.М., Отрошок Е.В. Полный травматический разрыв левого купола диафрагмы с дислокацией органов брюшной полости. Детская хирургия. 2017; 21 (1): 53–5 [Malanov S.V., Petrov M.M., Otroshok E.V. Complete traumatic rupture of diaphragmatic cupola with dislocation of abdominal organs. Russian Journal of Pediatric Surgery. 2017; 21 (1): 53–5 (in Russ.)]. doi: 10.18821/1560-9510-2017-21-1-53-55
  16. Fair K.A., Gordon N.T., Barbosa R.R. et al. Traumatic diaphragmatic injury in the American College of Surgeons National Trauma Data Bank: a new examination of a rare diagnosis. Am J Surg. 2015; 209 (5): 864–9. doi: 10.1016/j.amjsurg.2014.12.023
  17. Shaban Y., Elkbuli A., McKenney M. et al. Traumatic Diaphragmatic Rupture with Transthoracic Organ Herniation: A Case Report and Review of Literature. Am J Case Rep. 2020; 21: e919442. doi: 10.12659/AJCR.919442
  18. Алиев С.А., Рафиев С.Ф., Зейналов Б.М. Диагностика и хирургическое лечение разрывов диафрагмы. Хирургия. Журнал им. Н.И. Пирогова. 2010; 10: 22–8 [Aliev SA, Rafiev SF, Zeinalov BM. Diagnostics and surgical treatment of diaphragm ruptures. Pirogov Russian Journal of Surgery. 2010; 10: 22–8 (in Russ.)].
  19. Хаджибаев А.М., Алтыев Б.К., Шукуров Б.И. и др. Диагностика и хирургическое лечение ущемленных посттравматических грыж. Вестник экстренной медицины. 2015; 3: 5–9 [Khadjibaev A.M., Altyev B.K., Shukurov B.I. et al. Diagnosis and surgical treatment of strangulated posttraumatic diaphragmatic hernia. Bulletin of Emergency Medicine. 2015; 3: 5–9 (in Russ.)].

补充文件

附件文件
动作
1. JATS XML
2. Fig. 1. Multispiral computed tomography of the abdominal cavity and retroperitoneum with bolus contrast enhancement: defect of the left dome of the diaphragm with splenic angle of the colon and large omentum

下载 (65KB)
3. Fig. 2. Radiography of Patient Z.: a – review radiography of the chest in two projections; б, в – sighting radiography in two projections; г – sighting radiography in the supine position

下载 (373KB)
4. Fig. 3. Laparoscopy performed on Рatient Z.: a – view of the surgical field; б – the splenic angle of the colon and the greater omentum are detected in the posttraumatic diaphragmatic defect; в – posttraumatic hernia defect of the left dome of the diaphragm; г – plasty of the diaphragmatic defect with local tissues.

下载 (330KB)
5. Fig. 4. Review radiography of Рatient Ch. on admission to the surgical hospital

下载 (121KB)
6. Fig. 5. Multispiral computed tomography of Patient Ch.: a defect in the diaphragm, the colon goes through the defect into the pleural cavity

下载 (244KB)

版权所有 © Russkiy Vrach Publishing House, 2025