A CASE OF ACUTE EXACERBATION BY ANOTHER NEW IMPACT ON LATENT TRAUMATIC DIAPHRAGMATIC HERNIA FOR A 25-YEAR-PERIOD
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概要
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We experienced a case of exacerbation of traumatic hermia after a 25-year latent period by a new impact in a 70-year-old man, which occupied the left pleural cavity. There was a history of being buried alive by a land slide 25 years before, when the diaphragmatic hernia was not pointed out. Two years earlier before adminission he was pointed out a traumatic diaphragmatic hernia which was protruding gastric shadow in the left pleural cavity by upper GI series and plain chest X-ray film. This time, he had a traffic accident causing multiple trauma and was referred to the hospital, because chest X-ray examination visualized an opaques shadow and dyspnea progressed. Most of the left pleural cavity was occupied by the intestines, the trachea shifted to the right side, and the spleen was recognized in the pleural cavity by CT scan. Diaphragmatic hernia was diagnosed easily by chest X-ray examination. An emergency laparotomy was performed. The stomach, transverse colon, small intestine, omentum and spleen were protruding into the left pleural cavity. The omentum adhered with a part of an old rib fractured lesion. We inferred that former diaphragmatic hernia could have occurred 25 years before. After the operation, reexpansion of the collapsed left lower lobe was difficult and much pleural effusion was drained out for more than 2 weeks. Furthermore during course he developed barotrauma, atelectasis, sepsis, and delirious state, but was eventually recovered. He was transferred to the former hospital on the 54th-POD.
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