Mr. Peng’s thoracic CT picture Case description: 29-year-old Mr. Peng accidentally hit the guardrail while driving, although no bleeding could be seen, Mr. Peng still went to the hospital in time, and under examination, it was found that under the impact of gravity, 3/4 of Mr. Peng’s stomach actually “ran” into the chest cavity, and doctors immediately performed surgery to save Mr. Peng’s potentially necrotic stomach. Experts remind, but where the thorax and abdomen instantly subjected to strong violent impact, even if there is no bleeding must also be checked in a large hospital, so as to avoid embedded gastrointestinal and other abdominal organs hernia ischemia, rupture, necrosis, and even life-threatening. Mr. Peng, 29 years old, is a businessman who drove home after a small gathering with friends one day and unexpectedly mistook the brake for the gas pedal on the way and crashed into the roadside guardrail, although no bleeding symptoms were found. But a little fuzzy consciousness Mr. Peng felt breathing difficulties, chest tightness, chest pain, accompanied by nausea symptoms, want to vomit and can not vomit, the heart is very disturbed, they rushed to call the ambulance. After chest X-ray, chest and abdomen C T examination, the doctor found that Mr. Peng not only had the left 4th and 5th front rib fracture, left lung tissue contusion, soft tissue swelling of the adjacent side chest wall and subcutaneous pneumonia, but also some abdominal organs had entered the left thoracic cavity. According to Mr. Peng’s medical history, combined with the auxiliary examination report, the doctor suspected that Mr. Peng had a “traumatic diaphragmatic hernia” and performed an emergency open-heart surgery on the same day. During the operation, it was seen that Mr. Peng’s diaphragm had a 5 or 6 centimeters split, and most of the stomach tissue “ran” through the left side of the ruptured diaphragm into the chest cavity, which was confirmed as “traumatic diaphragmatic hernia”. Due to timely surgery, Mr. Peng’s stomach was not “stuck” into necrosis by the ruptured diaphragm, and the doctor returned the “displaced” stomach to the abdominal cavity and repaired the broken diaphragmatic hernia hole, blocking the possibility of the stomach “crawling upstairs” again. The doctor repaired the “displaced” stomach into the abdominal cavity and repaired the broken diaphragmatic hernia hole, blocking the possibility of the stomach “crawling upstairs” again. After the surgery, Mr. Peng recovered well and ate normally without any complications, and was discharged from the hospital shortly afterwards. The analysis of severe trauma or rupture of the diaphragm so that the abdominal organs have the opportunity to “crosstalk” hit the guardrail how to let most of Mr. Peng’s stomach “displaced” to the chest cavity? “The human thorax and abdomen in the moment when a strong external impact, may cause the diaphragm to tear, abdominal organs were hit into the thoracic cavity, the formation of traumatic diaphragmatic hernia.” Professor Zhang Lixi, director of thoracic surgery of the Third Affiliated Hospital of Southern Medical University, explained. Professor Zhang Lixi introduced that there is a diaphragm between the thoracic cavity and abdominal cavity of human body, and the diaphragm is like a wall separating the two. The esophagus passes through the hole reserved by the diaphragm, that is, the esophageal fissure, and connects to the stomach located below the diaphragm, and such a structure makes it uncommon for abdominal organs to enter the thoracic cavity. “Some patients are born with a large esophageal cleft, the stomach is easy to go up through the diaphragm resulting in ‘thoracic stomach’, but Mr. Peng’s esophageal cleft itself is normal, because in the process of hitting the guardrail in the thoracic abdomen was violently collided with a strong external force broke through the diaphragm, the stomach at once squeezed up into the thoracic cavity, but also by the diaphragm The rupture was stuck tightly. Traumatic diaphragmatic rupture and diaphragmatic hernia formation like this must be followed by emergency surgery.” Even if there is no damage on the outside, timely examination and diagnosis is necessary. Prof. Zhang Lixi recalled that when Mr. Peng was brought to the hospital, his clothes were intact, no injury was seen on his skin, and the stomach in the abdominal cavity was completely invisible on the outside. It was only through imaging that it was discovered that 3/4 of Mr. Peng’s stomach squeezed onto the ruptured diaphragmatic foramen and entered the thoracic cavity, squeezing the left lung into a size of less than 1/2. Because it was stuck in the diaphragm hole, the stomach in the chest cavity was distended and inflated, which is what made Mr. Peng appear nauseous but unable to vomit. “Usually in the case of serious injuries, if the brain is not injured, people do not appear vomiting symptoms, if they appear, it means that the gastrointestinal problems.” Chest and abdomen under the instantaneous violent external impact, if the liver and spleen rupture, there will be haemorrhage, easy to be found; but if the involvement of the gastrointestinal such cavernous organs, it is difficult to diagnose the damage from the appearance alone, must be clear through imaging, abdominal puncture and other examination methods abdominal conditions. Therefore, you should immediately go to a large hospital for examination to further exclude organ damage, otherwise, it may lead to toxic shock due to abdominal organ necrosis. Professor Zhang Lixi said, “If Mr. Peng feels that chest tightness and nausea is not a big deal, come back to the doctor after a day, the displaced stomach will most likely turn black due to ischemic necrosis.” Warning Chest and abdomen should be examined after experiencing instant external impact, such as chest X-ray “Traumatic diaphragmatic hernia can be detected by C T. Without such awareness, both patients and doctors may ignore it, leading to delayed disease, organ necrosis and adhesion of surrounding tissues, increasing the risk of surgery.” Professor Zhang Lixi said. However, if the doctor is not aware of traumatic diaphragmatic hernia, it is also difficult to notice signs of organ displacement from the abdominal cavity on the patient’s CT film. Therefore, after a momentary external impact on the chest and abdomen, do not assume that the absence of bleeding means that it is fine, Prof. Zhang Lixi suggests, “At least do chest X-ray, C T examination of the chest and abdomen, and if the abdomen bulges, blood pressure drops, and heartbeat accelerates, then you should do abdominal puncture or B ultrasound and other examinations.”