A case for diagnosis  (b)

 

    This patient was brought to A/E with acute onset severe dyspnea following breakfast after being fasting in Ramadan.

His BP was 70/40 mmHg.

Urgent chest x-ray was done (see  pict.)

what do u think the possible diagnosis ?

Another x-ray was taken (see the pic.)..... Do u still stick to your diagnosis?

The correct answer: (click here)

What was done in Rashid Hospital A/E room:

Surgical intervention:
Emergency left posterlateral thoracotomy was performed. There was a tear in the left copula of the diaphragm about 10 cm length. The whole stomach, spleen, omentum and large bowels were all passing through the tear to the chest cavity,

Abdominal contents were reduced to abdominal cavity. Repair of diaphragmatic tear was done using No. 1 and No. proline sutures.
Proline mesh was fixed over the sutured area.


Post operative care:
Patient was kept in ICU on ventilator for two full weeks to support the tear area and then on pressure support.
He was weaned off ventilator then extubated.

Patient was transferred to General surgical ward.


Physiotherapy:
Early mobilization and breathing exercises were done as soon as he was weaned off ventilator.


Discharge:
Patient was discharge after 25 days from admission.

Chest x-ray on discharge (see pic.)  showed:

End.