DIAGNOSIS AND TREATMENT OF POSTTRAUMATIC LEFT-SIDED DIAPHRAGMATIC HERNIA COMPLICATED BY STRANGULATION: THE CASE FROM PRACTICE

Aim. Improving the diagnosis and treatment of posttraumatic diaphragmatic hernia. Material and Methods. Analysed results of examination, diagnosis and surgical treatment of a 45 year-old patient. Results and Discussion. A 45 year-old patient was hospitalized on 06.07.2002 in the Department of Surgery ?1 of Lviv Regional Hospital on the 4-th day after the onset of pain in the left upper quadrant, nausea, bloating, constipation, and lack of gas. History: in 1987, the patient was operated after a penetrating injury of the left side of chest and abdomen; laparotomy, resection of the damaged segment of transverse colon, and transverse colostomy were performed. In 1988 a transverso-sigmo anastomosis "end to side" was made with the exception of the passage of the descending colon. Further detailed X-ray examinations of the chest, abdomen and diaphragm had not been performed. The general condition of the patient is moderate, marked pallor, respiratory rate - 24 / min, heart rate - 96 beats / min, blood pressure - 130/80 mm Hg. The thorax has a symmetrical shape, clear lung sound is determined on both sides,weakened vesicular breathing is heard under the left scapula. The abdomen is bloated, soft, anterior abdominal wall is involved in breathing, increased peristalsis of the intestines, urination is unimpaired. The diagnosis: posttraumatic left-sided diaphragmatic hernia complicated by strangulation. Conclusion. Compliance with the standard survey allowed us to establish the correct diagnosis, and to perform an optimal surgical intervention to achieve full recovery of the patient. Keywords: posttraumatic hernia of the diaphragm, diagnosis, surgical treatment