Diaphragmatic Rupture with Pancreatic Head and Duodenal Transection: a case report

橫膈破裂合併胰臟頭及十二指腸橫斷：個案報告

陳和庠(Ho-Hsiang Chen) ； 王者仁(Che-Jen Wang) ； 張凱惟(Kai-Wei Chang) ； 薛冠群(Kuan-Chun Hsueh) ； 吳肇鑫(Chao-Hsin Wu)

《童綜合醫學雜誌》 12卷2期 (2018/12) Pp. 102-107

https://doi.org/10.3966/207135922018121202005

摘要

Non-high-energy blunt diaphragmatic rupture is an uncommon injury that is challenging to diagnose in the emergency department. Computed tomography has the high sensitivity needed to detect injuries associated with the diaphragm as well as solid and hollow organs. Here, we present a rare case of blunt diaphragmatic rupture complicated with pancreatic head and duodenal transection. The patient suffered from a mild impact to the upper abdomen upon being hit by a car slowly moving in reverse. Computed tomography showed left diaphragmatic rupture and traumatic pancreatic injury. Her injuries were initially considered to be compressed solid organ-mimicking hematoma or bleeding; however, after urgent surgical operation, the pancreatic head and duodenal transection was found. The revised Injury Severity Score was 34. According to the literature, blunt traumatic diaphragmatic injury is associated with a high Injury Severity Score due to associated injuries requiring urgent surgery. Early diagnosis and surgical repair are recommended to avoid organ herniation and further damage after blunt diaphragmatic rupture.

關鍵字

Non-high-energy ； Blunt diaphragmatic rupture ； pancreatic head and duodenal transection

並列摘要

非高能量損傷造成鈍性膈肌破裂在急診部是少見且具有挑戰性的個案。電腦斷層掃描有更好的敏感性來偵測橫膈破裂並進一步發現是否有器官或中空臟器的損傷，我們報告一位罕見鈍傷性橫膈破裂傷合併胰臟及十二指腸橫斷的個案，她受到一輛轎車慢速倒車時輕微撞擊了上腹部。電腦斷層影像顯示左橫膈膜破裂及胰臟損傷，藉由緊急剖腹修補才發現除了橫膈破裂外合併胰臟頭以及十二指腸橫斷損傷，嚴重創傷指數為34，我們懷疑電腦斷層影像由於受擠壓的臟器掩飾了創傷的臟器及出血。根據文獻，鈍傷性膈損傷造成的高嚴重創傷指數，與需要緊急手術成相關性，因此，我們建議早期診斷和手術修復可以避免器官進一步損傷。

並列關鍵字

非高能量 ； 鈍傷性橫膈破裂 ； 胰臟頭部及十二指腸橫斷