Przeważająca liczba przypadków pęknięcia przepony (70-90%) dotyczy strony lewej. Mają one wówczas związek z urazami śledziony, żołądka i jelit. Jak najczęściej dochodzi do uszkodzenia przepony, jak rozpoznać i jak leczyć tego rodzaju uraz?
Do pęknięcia przepony dochodzi zazwyczaj w wyniku urazów tępych, najczęściej w skojarzeniu z uszkodzeniami narządów jamy brzusznej. Bez względu na mechanizm, w konsekwencji urazu przepony dochodzi do przemieszczania się narządów wewnętrznych pomiędzy jamą brzuszną a klatką piersiową.
Z uwagi na fizjologiczną różnicę ciśnień w obu jamach, narządy jamy brzusznej zazwyczaj wnikają do klatki piersiowej. To natomiast może powodować znaczne upośledzenie wentylacji.
Jak rozpoznać uraz przepony?
Pęknięcie przepony nie charakteryzuje się typowymi objawami, co powoduje, że jedynie ok. 40 proc. przypadków jej rozerwania rozpoznaje się bezpośrednio po zdarzeniu. Mogą jednak wówczas wystąpić takie symptomy, jak niewydolność oddechowa, zaburzenia rytmu serca, jak również szmery perystaltyczne jelit w klatce piersiowej. Ten ostatni możliwy jest do stwierdzenia w badaniu fizykalnym.
Jakie badania przeprowadza się w celu wykrycia urazu przepony?
Aby potwierdzić bądź wykluczyć pęknięcie przepony zazwyczaj wykonuje się RTG klatki piersiowej w pozycji stojącej. Dodatkowo sprawdzą się również takie badania jak USG, MR, jak również TK, które jest w stanie nie tylko wykryć uraz przepony, ale także rozpoznać pozostałe współistniejące uszkodzenia. Najczęściej jednak do rozpoznania pęknięcia przepony dochodzi podczas laparotomii, czyli operacyjnego otwarcia jamy brzusznej.
Jak wygląda postępowanie w przypadku rozpoznania urazu przepony?
Rozpoznanie uszkodzenia przepony leczy się najczęściej podczas zabiegu operacyjnego, zwykle laparotomii. Dzięki otwarciu jamy brzusznej możliwe jest nie tylko zszycie rozerwanego mięśnia, ale również skontrolowanie i zaopatrzenie innych uszkodzeń w jamie brzusznej, do których doszło podczas urazu.
Źródło: Głuszek S., Chirurgia Podstawy, Wydanie II uaktualnione i rozszerzone Warszawa 2019, s. 118
Przeczytaj także: Pierwsza pomoc przy oparzeniu chemicznym przełyku
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