Objective To investigate the causes and preventive measures of missed diagnosis of severe traumatic dia-phragmatic hernia(TDH)complicated with pericardial rupture.Methods The clinical data of 1 case of severe TDH compli-cated with pericardial rupture were retrospectively analyzed.Results The patient was transferred from another hospital due to progressive dyspnea and decreased blood pressure after a car accident,and it was difficult to maintain breathing and circulation after receiving invasive mechanical ventilation and drug use to increase blood pressure.Spiral CT showed bilateral rib fracture and left pneumothorax,and the condition worsened after closed drainage of left thoracic cavity.Arterial blood gas analysis re-vealed oxygen partial pressure of 53 mmHg,carbon dioxide partial pressure of 33 mmHg,and blood lactic acid of 6.8 mmol/L.After enhanced CT scan,it was found that the left lung was compressed and shifted upward,and the left thorac-ic cavity was connected to the esophagus.TDH was considered.Immediate exploration of the left chest under general anesthe-sia revealed rupture of diaphragm,laceration of pericardium,herniation of part of abdominal organs into the chest,restoration of organs,and repair of the tear.After surgery,the patient's breathing and circulation became stable rapidly.Blood lactic acid decreased to 1.6 mmol/L.One month later,he recovered and was discharged.Conclusion TDH complicated with pericardi-al rupture is rare;therefore,early diagnosis and treatment is the key.The awareness of diaphragmatic hernia should be main-tained at the time of admission.The source of chest gas indicated by CT should be carefully explored,and enhanced CT may be helpful for diagnosis.Blood lactic acid can be used to evaluate the severity of the disease,and gastric tube decompression and operation should be performed as soon as possible to relieve respiratory and circulatory obstruction.The surgical approach should be determined according to the injury condition.
维普
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