횡격막허니아에 병발한 긴장성기흉 1례

Abstract

A 1.86 kg, 3-year-old, female, Maltese was presented to the Veterinary Medical Teaching Hospital of SeoulNational University after being hit by a car. The patient was diagnosed with urinary bladder rupture, diaphragmatichernia and fracture of ilium, tibia and fibula. Repair surgery was performed after stabilizing treatment. During thesurgery, hypoxia was identified and it worsened after positive pressure ventilation (partial pressure of oxygen in arterialblood (PaO2): 52 mmHg, pulse oximetry (SpO2): 87%, arterial hemoglobin oxygen saturation (SaO2): 85.8%). In additionto hypoxia, blood pressure decreased to 30 mmHg. Positive pressure ventilation was discontinued because hypoxiaand hypotension were aggravated. After suturing the diaphragm, air was withdrawn to form negative pressure withinthe thorax. However, negative pressure was not attained despite continuous withdrawal of air. A thoracostomy tubewas placed because tension pneumothorax was strongly suspected. The patient recovered through close monitoringwith the tube for 3 days. Due to limitation of evaluation of the lung, predicting occurrence of tension pneumothoraxis difficult in patient of diaphragmatic hernia. Therefore, it is recommended that indicators of tension pneumothoraxshould be closely monitored during diagnosis and repair procedures of diaphragmatic hernia.