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Small bowel strangulation due to peritoneopericardial diaphragmatic hernia.

Lee JH, Kim SW - J Cardiothorac Surg (2014)

Bottom Line: A 75-year-old Korean man was referred to our hospital with cramping abdominal pain.We performed surgery and confirmed peritoneopericardial diaphragmatic hernia with small bowel strangulation.Postoperative course was uneventful.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Thoracic and Cardiovascular Surgery, College of Medicine, Yeungnam University, Daemyeong 5-dong, Nam-gu, Daegu 705-717, Korea. heartljh@yumail.ac.kr.

ABSTRACT
A 75-year-old Korean man was referred to our hospital with cramping abdominal pain. His chest X-ray showed an abnormal air shadow above the diaphragm, and computed tomography showed an abdominal viscera in the pericardium. We performed surgery and confirmed peritoneopericardial diaphragmatic hernia with small bowel strangulation. Postoperative course was uneventful. Peritoneopericardial diaphragmatic hernia is very rare in humans, so we report the case with a literature review.

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Computed tomography (CT) demonstrates a loop of intestine in the pericardial space (arrow).
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Figure 2: Computed tomography (CT) demonstrates a loop of intestine in the pericardial space (arrow).

Mentions: A 75-year-old Korean male patient was referred to our emergency department with cramping abdominal pain for three days. He also had dyspnea and chest discomfort. He had diabetes mellitus and no history of trauma. Upon his arrival at the emergency department, his blood pressure was 150/100 mmHg, heart rate 102 per minute, respiratory rate 22 per minute and body temperature 37.5°C. On physical examination there was direct tenderness on the whole abdomen and we could hear rale in both lower lung fields. Laboratory studies showed leukocytosis and a leukocyte count of 1,500. An x-ray of the chest showed abnormal air shadows above the diaphragm (Figure 1). Computed tomography showed what appeared to be a loop of intestine in the pericardium (Figure 2). We performed an emergency operation with median laparotomy. The small bowel was herniated to the pericardial space through the diaphragmatic defect and the herniated bowel was edematous and strangulated. We pulled the herniated bowel for an easy manual reduction. After the reduction of the herniated bowel, we identified the diaphragmatic defect. The defect was located at the left side of the central tendinous portion and had no communication with the pleural space. The defect was 3 × 3 cm in size with a round shape, and the margin of the defect was smooth and thick. We could see the heart beat through the defect. We resected the strangulated small bowel and performed end-to-end anastomosis. The defect was closed with Gortex patch with interrupted ethibond sutures. On chest x-ray after operation, no bowel gas was seen in the chest (Figure 3). The patient received ventilator care during the immediate postoperative period. On the fourth postoperative day, the patient was transferred to a general ward and the postoperative course was uneventful. The patient was discharged on the ninth postoperative day. We concluded that the patient’s final diagnosis was small bowel strangulation due to peritoneopericardial diaphragmatic hernia.


Small bowel strangulation due to peritoneopericardial diaphragmatic hernia.

Lee JH, Kim SW - J Cardiothorac Surg (2014)

Computed tomography (CT) demonstrates a loop of intestine in the pericardial space (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4230424&req=5

Figure 2: Computed tomography (CT) demonstrates a loop of intestine in the pericardial space (arrow).
Mentions: A 75-year-old Korean male patient was referred to our emergency department with cramping abdominal pain for three days. He also had dyspnea and chest discomfort. He had diabetes mellitus and no history of trauma. Upon his arrival at the emergency department, his blood pressure was 150/100 mmHg, heart rate 102 per minute, respiratory rate 22 per minute and body temperature 37.5°C. On physical examination there was direct tenderness on the whole abdomen and we could hear rale in both lower lung fields. Laboratory studies showed leukocytosis and a leukocyte count of 1,500. An x-ray of the chest showed abnormal air shadows above the diaphragm (Figure 1). Computed tomography showed what appeared to be a loop of intestine in the pericardium (Figure 2). We performed an emergency operation with median laparotomy. The small bowel was herniated to the pericardial space through the diaphragmatic defect and the herniated bowel was edematous and strangulated. We pulled the herniated bowel for an easy manual reduction. After the reduction of the herniated bowel, we identified the diaphragmatic defect. The defect was located at the left side of the central tendinous portion and had no communication with the pleural space. The defect was 3 × 3 cm in size with a round shape, and the margin of the defect was smooth and thick. We could see the heart beat through the defect. We resected the strangulated small bowel and performed end-to-end anastomosis. The defect was closed with Gortex patch with interrupted ethibond sutures. On chest x-ray after operation, no bowel gas was seen in the chest (Figure 3). The patient received ventilator care during the immediate postoperative period. On the fourth postoperative day, the patient was transferred to a general ward and the postoperative course was uneventful. The patient was discharged on the ninth postoperative day. We concluded that the patient’s final diagnosis was small bowel strangulation due to peritoneopericardial diaphragmatic hernia.

Bottom Line: A 75-year-old Korean man was referred to our hospital with cramping abdominal pain.We performed surgery and confirmed peritoneopericardial diaphragmatic hernia with small bowel strangulation.Postoperative course was uneventful.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Thoracic and Cardiovascular Surgery, College of Medicine, Yeungnam University, Daemyeong 5-dong, Nam-gu, Daegu 705-717, Korea. heartljh@yumail.ac.kr.

ABSTRACT
A 75-year-old Korean man was referred to our hospital with cramping abdominal pain. His chest X-ray showed an abnormal air shadow above the diaphragm, and computed tomography showed an abdominal viscera in the pericardium. We performed surgery and confirmed peritoneopericardial diaphragmatic hernia with small bowel strangulation. Postoperative course was uneventful. Peritoneopericardial diaphragmatic hernia is very rare in humans, so we report the case with a literature review.

Show MeSH
Related in: MedlinePlus