Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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Lung herniation is uncommon and has been defined as the protrusion of pulmonary tissue and pleural membranes through defects of the thoracic wall. In combination with rib fractures caused by single massive coughing fit, spontaneous lung herniation has previously been reported only three times. To our knowledge, in combination with multiple rib fractures and flail chest, as in the case presented, it has never been reported. ⋯ After resection of the herniated pleural membrane, a 30 x 30-cm polypropylene mesh was fixed to the diaphragm and with nonresorbable pericostal sutures to the thoracic wall. With this procedure, the loss in stability caused by the ruptured anterior intercostal muscular system could be restored. The postoperative course was uneventful, and the patient was dismissed on day 12.
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Delirium and intensive care unit (ICU) syndrome are frequently seen postoperatively, especially in intensive care. Hospital mortality and complication rates are higher in patients with these disorders. ⋯ Knowledge of differential diagnosis and causality is essential for curative therapy. Drug therapy is recommended for the treatment of psychotic symptoms and vegetative disorders.