Incarcerated Diaphragmatic Herniation of the Stomach Mimicking Empyema Thoracis

箝頓性膈疝胃突出模擬膿胸

戴佩玲(Agatha Te) ； 林麗眞(Li-Chen Lin) ； 盧朝勇(Jau-Yeong Lu) ； 葉本芳(Pen-Fong Yeh) ； 楊明松(Ming-Sung Yang) ； 郭文雄(Wein-Shung Kuo)

《重症醫學雜誌》 9卷4期 (2008/12) Pp. 267-274

https://doi.org/10.30035/TCCM.200812.0006

摘要

這位病人來醫院時表現胸痛和發燒兩天。胸部影像及胸腔超音波呈現左側大量肋膜積水。以胸腔超音波指引肋膜穿刺引流土褐色液體認爲是膿胸。經左後側胸廓切開術後發現有部份的胃壞死來自橫膈破裂之處突出在左側胸腔內，並發現胃內裝著土褐色有臭味的胃液，證實左側肺無大量肋膜積水或膿胸，而是箝頓性膈疝胃突出。病患接受肋膜切除術，和部份切除胃近端有壞死的地方，並進行橫膈破裂之修補。箝頓性膈疝胃突出是外科急診。能夠及時診斷並積極外科治療可以拯救病人的生命。

關鍵字

膿胸 ； 箝頓性膈疝 ； 胃壞死

並列摘要

A patient presented to our hospital complaining of chest pain and fever for two days. A chest x-ray revealed opacity of the left hemithorax suggesting massive pleural effusion. Thoracocentesis under the guidance of chest sonography aspirated a foul-smelling muddy-brown fluid. During a left posterolateral thoracotomy for decortication, a gangrenous proximal third of the stomach was found within the left thoracic cavity incarcerated in the left hemidiaphragmatic defect. The stomach contained muddy-brown, foul-smelling necrotic gastric contents which made us realize that the empyema we aspirated before was actually the contents of the stomach. A partial gastrectomy of the proximal gangrenous stomach anddecortication of the pleura was performed and the ruptured diaphragm was repaired. An incarcerated diaphragmatic hernia of the stomach is a surgical emergency. We should keep a high index of suspicion of the diagnosis and it should be included as a differential diagnosis in the case of intestinal obstruction with a history of trauma. Aggressive surgical treatment may save the patient's life.

並列關鍵字

Empyema thoracis ； Incarcerated diaphragmatic hernia ； Stomach gangrene