<Case Report>A Patient with a Traumatic Right Diaphragmatic Hernia Occuring 4 Years After Sustaining Injury : Statistical Observations of a Delayed Diaphragmatic Hernia Caused by Uncomplicated Injury in Japan

Abstract

We describe our experience with a patient in whom a traumatic right diaphragmatic hernia developed 4 years after sustaining injury and review cases of delayed diaphragmatic injury reported in Japan. The patient was a 28-year-old man who sustained a severe contusion of the right epigastric region and fractured a right rib in a traffic accident in September 1992. In August 1996, the patient presented with shortness of breath on effort or after meals. A chest roentgenogram revealed intestinal gas in the right side of the thoracic cavity. A right diaphragmatic hernia was diagnosed on the basis of a gastrointestinal series, and the patient was operated on. The hernial orifice extended anteriorly from the central tendon in an 11:00 direction and measured 11×6 cm. The small intestine, right side of the colon, and liver were herniated. A total of 297 cases of blunt traumatic diaphragmatic hernia were reported in Japan between 1981 and 1996, including 47 cases (left side, 32 cases; right side, 15 cases) of delayed diaphragmatic hernia, defined as occurring one month or more after injury. Diaphragmatic hernia should be considered as a possible diagnosis in patients with abnormal shadows in the thoracic region who have recently sustained injury or who have a past history of injury.

受傷後4年を経過して発症した外傷性右横隔膜へルニアの1例と本邦の鈍的外傷性横隔膜へルニアの報告例の統計的観察について検討した. 【症例】28歳, 男性. 1992年9月交通事故により右肋骨骨折を伴う右上腹部の鈍的外傷を受けた. 1996年8月労作時や食後の息切れが出現した. 胸部X-P 写真およひ消化管造影検査で右横隔膜ヘルニアと診断し手術を施行した. 破裂部位は右横隔膜の腱中心の前方11時方向で, 筋線維方向に 11×6cm の破裂部位を認めた. 脱出臓器は小腸, 右結腸および肝右葉であった. また, 1981年から1996年までに本邦で鈍的外傷による横隔膜へルニアの報告例は297例であった. そのうち受傷後1ヶ月以降に発症した遅発性横隔膜ヘルニアは47例 （右32例, 左15例）であった. 受傷直後はもとより外傷の既往があり, 胸部異常陰影のある患者には本疾患を念頭におくことが大切である.