Transdiaphragmatic Intercostal Hernia
Introduction
Introduction to the intercondylar iliac crest Transdiaphragmatic intercostal hernia is a hernia formed by the bulging of the abdominal organs through the "weak area" of the chest wall. Manrer and Blades (1946) first reported the disease, accurately and detailedly describing 4 patients, Croce and Mehta (1979) reported the disease under the name "intercostal pleural effusion". Cole et al. (1986) named the disease as intercondylar spasm of the diaphragm. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: incomplete intestinal obstruction
Cause
Transpilation of the intercondylar iliac crest
(1) Causes of the disease
According to the comprehensive literature, common causes of intercondylar spasm of the diaphragm are:
Trauma
Such as stab wounds, car accidents and other sharp or blunt trauma, and more rib fractures, according to statistics, combined with rib fractures accounted for 83% of all cases, trauma caused by the intercostal intercostal hernia, from trauma to intra-abdominal organ The diaphragm is pulled out from the intercostal space. It usually takes several months to several years, with an average of about 5 months. The earliest one can be infected after the injury. There are reports of the disease in 36 years after the injury.
2. Spontaneous injury
For example, elderly patients with chronic obstructive pulmonary emphysema and osteoporosis may have intercostal muscle tears due to severe cough, and even spontaneous fractures of osteoporotic ribs, resulting in a weak chest wall.
Under normal circumstances, the lack of intercostal muscle support from the rib to the sternum, from the rib angle to the spine lacks the support of the intercostal muscles, constitutes two potential anatomical weak areas of the chest wall, these two chest wall The area is more prone to intercostal muscle tears and is more prone to intercondylar spasm of the diaphragm.
Intercostal muscle tears and rib fractures destroy the integrity of the chest wall, providing a potentially weak area for the occurrence of sputum. If the patient is accompanied by traumatic diaphragm rupture, sputum, severe cough can increase the rupture of the diaphragm and make the abdominal viscera more More into the chest cavity, and finally the abdominal organs into the intercostal space, the formation of the intercondylar iliac crest, sometimes the lower rib fracture, the broken end can pierce the adjacent diaphragm, causing paralysis, and then developed into the intercostal intercondylar spasm, The weak chest wall can occur anywhere in the chest wall, but the 9th intercostal space is the most common of the 12 patients reported in the literature, accounting for about 75% of all reported cases.
(two) pathogenesis
The "inner ring" of the intercondylar iliac crest is the rupture of the diaphragm, the outer ring is the rib fracture, the intercostal muscle tear causes the weak part of the chest wall, and the sac is covered as the weak layer of the chest wall, which can have the sac and the sac. It consists of the pleural wall layer or the peritoneum. The contents of the sputum are various organs in the abdominal cavity. The liver, small intestine, colon and omentum are common in the literature. There are no reports of stomach and spleen sputum, and the contents are easier. Reset, rare incarceration.
Prevention
Intercostal intercondylar fistula prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Intercostal intercondylar complication Complications incomplete intestinal obstruction
Incomplete intestinal obstruction.
Symptom
Intercostal intercondylar symptoms of the diaphragmatic muscles Common symptoms Bowel and palsy
The typical performance is that there is a reversible mass on the lower chest wall, and the mass increases when inhaling, and the mass shrinks when exhaling, and the cough has a sense of impact. If the content of the sputum is small intestine or colon, the patient may have incomplete intestine. The performance of the obstruction can be heard on the surface of the chest wall mass.
Examine
Examination of the intercostal hernia of the diaphragm
Chest X-ray film
Visible rib fractures, intestinal shadows appear in the thoracic cavity above the diaphragm level, intestinal air-liquid plane or dense shadow.
2. Digestive tract barium angiography
It can be seen that the sputum and the sputum entering the small intestine or colon are juxtaposed on the plane of the diaphragm and protruding toward the chest wall mass. The sputum continuously flows into the small intestine or colon of the iliac crest, and then flows into the small intestine or colon of the abdominal cavity.
3.CT scan
Examination can further clarify the location of the diaphragmatic rupture and the nature of the organ.
Diagnosis
Diagnosis and diagnosis of intercostal intercondylar diaphragm
Diagnostic criteria
History
Patients have a history of trauma or a history of chronic obstructive emphysema.
2. Clinical manifestations
There is a reversible mass in the chest wall, and it shrinks or increases with respiratory movement; the cough impact test is positive, may have the performance of incomplete intestinal obstruction, or the chest wall mass can smell the bowel sounds.
3. X-ray inspection
Visible rib fractures, intestinal shadows in the chest, intestinal air-liquid plane or dense shadows.
Differential diagnosis
According to the typical clinical manifestations, as well as chest X-ray film is not difficult to diagnose the disease, but must be differentiated from intercostal pulmonary hernia, the chest wall mass formed by intercostal pulmonary spasm is characterized by increased exhalation , decrease when inhaling.
