% JliilPi of Hospital frai^c. CA.SE
OF
TRAUMATIC
DIAPHRAGMATIC-
HERNIA* By Mr. NARAYANA
SWAMY,
Madras.
A l'OUNG the Native
man
of 21 years
was
admitted into
Infirmary, Royapuram,
on the 28th p.m., for severe injury to the back sustained whilst at work in the Kailway Workshop at Royapuram. It was said to have been caused in the following manner: The patient and a few other coolies were engaged in raising a very heavy bunk to fix it to a railhe supporting the centre of it on way carriage, his back ; and while doing so the coolies accidentally let go their hold, with the result, that the patient fell prostrate on the floor under the heavy weight of the bunk, sustaining the fatal injury, lie was immediately conveyed to the hospital for treatment. I saw the patient on the following morning, nearly 15 hours after the receipt of the injury. He was in a collapsed condition ; pulseless at the wrist; skin cold and clammy; breathing hurried and shallow, nearly 50 in a minute ; face anxiou3, pale and pinched ; abdomen was distended but the distension was peculiar, inasmuch as it was particularly confined to the upper part about the umbilicus which was tym-
February 1808,
*
at 4
Rend before the S. Indian Branch of
Association.
British Medica!
April
1899.]
DIAPHRAGMATIC HERNIA?ABDOMINAL SECTION COMPLICATIONS.
paniticon percussion
; and this tympanitic sound also elicited all over the right chest. Lower 'limbs were first completely powerless, but later on the patient was able to flex his knees thus revealing no damage done to the spinal cord ?except concussion. There was an immense swelling occupying the lower portion of the dorsal and upper portion of the lumbar regions (on which the bunk fell), the tissues of which were severely contused. A careful examination failed to discover any fracture of the spine or ribs. The bladder was twice relieved by a catheter. The patient complained of difficulty of breathing and pain in the abdomen and right side ot ?chest. There was neither nausea nor vomiting, internal hemorrhage being suspected ice bags were applied to the injured parts and stimulants were administered. The patient gradually grew worse and died at 10 a.m. on the 1st March 1S9S, ?evidently from the effects of severe shock. An inquest was held on the following morning, nearly 21 hours after death. I witnessed the post-mortem conducted by Mr. II. S. Halge, Resident Apothecary of the Hospital, and 'found a large rent in the muscular portion of j A the costal attachment of the right half of the i diaphragm about 2 inches from the .interior medial line. It was almost circular, about 8| inches in circumference and nearly 3 inches in diameter. A large number of coils of distended -small intestines (jejunum and a portion of ileum) protruded through the lacerated diaphragm and entered into the right- pleural cavity, reaching as high as the 2nd rib, compressing the right lung against the posterior thoracic wall which was completely collapsed and considerably congested. The hernial portion of the intestines also presented a slightly congested apnearance but not that of strangulation ; the length of the pro- 1 I he truded intestine being nearly 13 feet. stomach was enormously distended. A large ; ?quantity of clotted blood was found behind the peritoneum surrounding the lower portion of the j of i due to was
|
ascending colon, evidently some
of the branches of the
rupture
superior mesenteric
amount of extravasated discovered in the right half of the hypogastric region between the peritoneum and the transversalis fascia. The sternal end of the ?1th right rib was factured without the slightest displacement of the broken fragments. Pelvic bones were entire, and all the other abdominal and pelvic organs were normal. Diaphragmatic hernia? are universally accepted as extremely rare, and the traumatic variety of this special hernia is rarer still. This fact is 5 cases in the the record of
artery. blood
Considerable
was
only
supported by
last 20 volumes of the Hvitish Medical Jouvnal. Not one of these is a traumatic diaphragmatic hernia. The and interest, therefore,
importance
?f the case now reported to the upon its extreme rarity.
meeting depend
121
OF
TRAUMATIC
DIAPHRAGMATIC-
HERNIA* By Mr. NARAYANA
SWAMY,
Madras.
A l'OUNG the Native
man
of 21 years
was
admitted into
Infirmary, Royapuram,
on the 28th p.m., for severe injury to the back sustained whilst at work in the Kailway Workshop at Royapuram. It was said to have been caused in the following manner: The patient and a few other coolies were engaged in raising a very heavy bunk to fix it to a railhe supporting the centre of it on way carriage, his back ; and while doing so the coolies accidentally let go their hold, with the result, that the patient fell prostrate on the floor under the heavy weight of the bunk, sustaining the fatal injury, lie was immediately conveyed to the hospital for treatment. I saw the patient on the following morning, nearly 15 hours after the receipt of the injury. He was in a collapsed condition ; pulseless at the wrist; skin cold and clammy; breathing hurried and shallow, nearly 50 in a minute ; face anxiou3, pale and pinched ; abdomen was distended but the distension was peculiar, inasmuch as it was particularly confined to the upper part about the umbilicus which was tym-
February 1808,
*
at 4
Rend before the S. Indian Branch of
Association.
British Medica!
April
1899.]
DIAPHRAGMATIC HERNIA?ABDOMINAL SECTION COMPLICATIONS.
paniticon percussion
; and this tympanitic sound also elicited all over the right chest. Lower 'limbs were first completely powerless, but later on the patient was able to flex his knees thus revealing no damage done to the spinal cord ?except concussion. There was an immense swelling occupying the lower portion of the dorsal and upper portion of the lumbar regions (on which the bunk fell), the tissues of which were severely contused. A careful examination failed to discover any fracture of the spine or ribs. The bladder was twice relieved by a catheter. The patient complained of difficulty of breathing and pain in the abdomen and right side ot ?chest. There was neither nausea nor vomiting, internal hemorrhage being suspected ice bags were applied to the injured parts and stimulants were administered. The patient gradually grew worse and died at 10 a.m. on the 1st March 1S9S, ?evidently from the effects of severe shock. An inquest was held on the following morning, nearly 21 hours after death. I witnessed the post-mortem conducted by Mr. II. S. Halge, Resident Apothecary of the Hospital, and 'found a large rent in the muscular portion of j A the costal attachment of the right half of the i diaphragm about 2 inches from the .interior medial line. It was almost circular, about 8| inches in circumference and nearly 3 inches in diameter. A large number of coils of distended -small intestines (jejunum and a portion of ileum) protruded through the lacerated diaphragm and entered into the right- pleural cavity, reaching as high as the 2nd rib, compressing the right lung against the posterior thoracic wall which was completely collapsed and considerably congested. The hernial portion of the intestines also presented a slightly congested apnearance but not that of strangulation ; the length of the pro- 1 I he truded intestine being nearly 13 feet. stomach was enormously distended. A large ; ?quantity of clotted blood was found behind the peritoneum surrounding the lower portion of the j of i due to was
|
ascending colon, evidently some
of the branches of the
rupture
superior mesenteric
amount of extravasated discovered in the right half of the hypogastric region between the peritoneum and the transversalis fascia. The sternal end of the ?1th right rib was factured without the slightest displacement of the broken fragments. Pelvic bones were entire, and all the other abdominal and pelvic organs were normal. Diaphragmatic hernia? are universally accepted as extremely rare, and the traumatic variety of this special hernia is rarer still. This fact is 5 cases in the the record of
artery. blood
Considerable
was
only
supported by
last 20 volumes of the Hvitish Medical Jouvnal. Not one of these is a traumatic diaphragmatic hernia. The and interest, therefore,
importance
?f the case now reported to the upon its extreme rarity.
meeting depend
121
