Посттравматические диафрагмальные грыжи (диагностика и лечение)

Abstract

The aim of the study: analysis of the results of treatment of patients with post-traumatic diaphragmatic hernia. Material and methods. For the period from January 1995 to September 2016, 6 patients with post-traumatic diaphragmatic hernia were treated in the clinic. Among the patients there were 5 men and 1 woman. The age of patients was from 18 to 52 years. All patients were admitted to the hospital when complications appeared. In one case the diagnosis of hernia was established at the hospital at the place of residence during a survey. The remaining patients were hospitalized with a diagnosis: pleural empyema on the left, bronchopleural fistula (1), pathology of the abdominal cavity (2), intercostal neuralgia (1), and spontaneous pneumothorax (1). All patients had a chest injury or a blunt abdominal trauma: 4 were treated for this diagnosis (blunt abdominal trauma - 3, non-penetrating stab-cut wound of thorax -1), one patient was treated outpatiently, in 1 case there was no hospitalization. Results. Surgical intervention was performed after shortterm preoperative preparation. The purpose of the operation: elimination of the defect of the diaphragm and correction of complications. Operative access was upper-median laparotomy and revision of abdominal organs. We consider it optimal for adequate revision of the abdominal cavity organs, evaluation of the pleural cavity state, and suturing the diaphragm. The defect of the left dome of the diaphragm was found in all cases. Repeated intervention was performed in one patient 3 days after the first operation. One patient died. Conclusion. It is necessary to develop a protocol for the diagnosis and treatment of patients with post-traumatic diaphragmatic hernias to improve treatment outcomes.