Congenital retrosternal diaphragmatic hernia
Introduction
Introduction to congenital sternal posterior tibia The abdominal organs protrude into the thoracic palpebral horn through the thoracic rib triangle, which is called congenital sternal posterior iliac crest, also known as retrosternal hernia, parasternal hernia, anterolateral hernia or Morgangri hiatus. The disease is rare, accounting for 3% to 5% of sputum. It can be diagnosed in the neonatal period. It is more common in adulthood. The right thoracic cavity is often caused by respiratory and digestive symptoms. If intestinal incarceration occurs, chest and abdominal infection may occur. basic knowledge The proportion of sickness: 0.01% Susceptible population: newborn Mode of infection: non-infectious Complications: aortic intestinal fistula
Cause
Congenital sternal posterior sac
Physical and chemical factors (65%):
Since the diaphragm is composed of the xiphoid process and the 7th to 10th ribs, the two groups of muscles on the inner surface have a potential pore at the junction, called the Morgagni hole (also known as the thoracic rib triangle), and the internal mammary artery passes through and evolves downward. In the intra-abdominal artery, during the development of the embryo, if the two groups of muscle capsules that form the diaphragm are obstructed, they do not completely heal, or form a weak area with only two layers of mucosa and a small amount of connective tissue. Under the influence of the pressure difference between the chest and the abdomen in the future, Some organs in the abdominal cavity can thus protrude into the thoracic cavity to form sputum.
Disease factors (35%):
Due to the strengthening effect of the pericardium, the left chest rib triangle is relatively tougher than the right side, so the right sternum posterior iliac crest is frequent. In most cases, the sternal posterior tibia has a hernia sac, and its contents are mostly omentum and colon, right. Lateral sternal bones are also very common in the liver, and there are fewer stomach intrusions.
Prevention
Congenital prevention of posterior sternum
There are no effective preventive measures for this disease.
Complication
Congenital sternal posterior iliac complications Complications aortic intestinal fistula
1. If the intubation of the intestine occurs with a blood vessel disorder or strangulation, intestinal bleeding, intestinal necrosis or perforation may occur.
2. Thoracic and abdominal infections.
Symptom
Congenital sternal sacral symptoms Common symptoms Upper abdominal pain, bloating, dyspnea, abdominal muscle tension, shortness of breath, shortness of breath, weakened, indigestion, intestinal sensation, loss of appetite, inhalation
Most congenital sternal posterior sacral patients have no specific clinical symptoms, often found by physical examination or X-ray examination for some reason. A small number of patients have recurrent episodes of discomfort in the upper abdomen or sternum, pain, accompanied by bloating or vomiting. Symptoms, children usually due to supine position, crying or increased abdominal pressure, severe cases of paroxysmal dyspnea, shortness of breath, bruising, etc.; when standing, quiet, abdominal pressure decreased, the above symptoms disappeared or reduced If the intestines in the chest cavity are incarcerated, vomiting, abdominal distension, and cessation of exhaustion and defecation will occur. If the intubation of the intestine occurs with a blood vessel disorder or strangulation, intestinal bleeding and blood in the stool may occur; Necrosis of the intestine, perforation, and chest and abdominal infections.
Physical examination: You can smell the bowel sounds on the chest wall.
Examine
Congenital examination of the posterior sternum
When clinical complications occur, white blood cell counts and the like can be increased.
X-ray examination is the most important means of diagnosing this disease.
1. Chest fluoroscopy or chest chest fluoroscopy or chest anterior film can be seen in the palpitations with a circular or elliptical shadow protruding to the chest, lateral shadows visible in the posterior sternal cerebral palpebral horn area, or see the anterior region, sternal posterior inflated Liquid level shadow.
2. Barium meal or barium enema examination of barium meal perspective, barium enema should be one of the preferred methods of examination, it can not only confirm the diagnosis, but also can clearly into the type of abdominal organs in the thoracic cavity, barium meal perspective can show the stomach into the chest cavity If the contents of the sputum are colon, the colon can be seen into the chest cavity when the sputum is enema, and the sacral and sacral sacs are close to the posterior edge of the sternum and have a "V" shape or a "U" shape image.
3. Artificial pneumoperitoneum examination is especially suitable for the right sternal posterior iliac crest of the liver, which is important for the diagnosis of this disease.
4. CT scan can clearly display the ankle ring and its contents.
Diagnosis
Diagnosis and diagnosis of congenital sternal posterior tibia
The disease lacks typical clinical features and often delays diagnosis and treatment. The disease can be considered in combination with the following medical history and X-ray examination.
1. A history of recurrent episodes of discomfort in the abdomen or sternum, dull pain, often due to crying and changes in body position, the attack or aggravation and difficulty breathing, rapid.
2. X-ray examination X-ray plain film shows a semi-circular shadow or a liquid-gas plane in the palpebral palpebral palpebral area. The barium enema can be seen in the thoracic cavity. The artificial pneumoperitoneum examination is used to diagnose liver intrusion. The chest is important.
Clinically, the disease is often misdiagnosed as a lung tumor and a mediastinal tumor, which must be identified.
