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Complicated adult right-sided Bochdalek hernia with Chilaiditi ’ s syndrome: a case report

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ABSTRACT

An extremely rare adult case that underwent surgery for ileus caused by Bochdalek hernia associated with Chilaiditi’s syndrome is presented. A 65-year-old woman complaining of upper abdominal pain presented to our hospital. Abdominal plain radiography showed increased intestinal gas, and computed tomography (CT) showed the transverse colon located above the right lobe of the liver, representing Chilaiditi’s sign. She was diagnosed as having ileus and treated with decompression therapy by a nasoenteric tube. After hospitalization, the patient developed dyspnea, and CT showed intestinal herniation into the right thoracic cavity. She was diagnosed as having strangulated ileus caused by Bochdalek hernia. An emergent laparotomy was performed, and it showed a hole of 5 cm in diameter at the right hemi-diaphragm. The transverse colon was incarcerated through the hole, it was pulled back to the abdominal cavity, and a right hemicolectomy was performed because of necrotic changes. A small part of the liver was also herniated into the right thoracic cavity, and it was returned to the abdominal cavity. The defect in the diaphragm was closed by direct suture. Although the patient developed an abscess in the thoracic cavity postoperatively, she improved with antibiotic therapy and was discharged 2 months after the operation.

No MeSH data available.


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Sagittal sequence of CT shows intestinal incarceration in the right thoracic cavity through the hole through which a part of the liver has herniated (arrow)
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Fig2: Sagittal sequence of CT shows intestinal incarceration in the right thoracic cavity through the hole through which a part of the liver has herniated (arrow)

Mentions: A 65-year-old woman visited our hospital with a complaint of continuous upper abdominal pain. She had a medical history of rheumatoid arthritis and was on prednisolone 5 mg a day. On admission, she was afebrile and had no abdominal distention, but she had tenderness over the whole abdomen, and her bowel sounds were slightly decreased. Apart from minimal hypokalemia, her laboratory values were normal. Abdominal X-ray showed small intestinal gas and the computed tomography showed the transverse colon located above the right lobe of the liver, known as Chilaiditi’s sign (Fig. 1a). A small part of the liver and intestinal fat tissue had also been seen in the bottom of the right thoracic cavity, probably due to the congenital hernia (Fig. 1b, c). She was diagnosed as having ileus due to Chilaiditi’s syndrome and was treated with decompression therapy by a nasoenteric tube. Four days later, she developed dyspnea and her abdominal pain worsened. Laboratory examination showed elevations in the white blood cell count (10,900/μl), C-reactive protein (19.48 mg/dl), fibrin/fibrinogen degradation products (FDP) (12.1 μg/ml), aspartate aminotransferase (AST) (43 U/l), and alanine aminotransferase (ALT) (43 U/l). Chest-abdominal computed tomography (CT) showed intestinal incarceration in the right thoracic cavity (Fig. 2). With these findings, the patient was diagnosed as having incarceration due to a right Bochdalek hernia and Chilaiditi’s syndrome.Fig. 1


Complicated adult right-sided Bochdalek hernia with Chilaiditi ’ s syndrome: a case report
Sagittal sequence of CT shows intestinal incarceration in the right thoracic cavity through the hole through which a part of the liver has herniated (arrow)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4595410&req=5

Fig2: Sagittal sequence of CT shows intestinal incarceration in the right thoracic cavity through the hole through which a part of the liver has herniated (arrow)
Mentions: A 65-year-old woman visited our hospital with a complaint of continuous upper abdominal pain. She had a medical history of rheumatoid arthritis and was on prednisolone 5 mg a day. On admission, she was afebrile and had no abdominal distention, but she had tenderness over the whole abdomen, and her bowel sounds were slightly decreased. Apart from minimal hypokalemia, her laboratory values were normal. Abdominal X-ray showed small intestinal gas and the computed tomography showed the transverse colon located above the right lobe of the liver, known as Chilaiditi’s sign (Fig. 1a). A small part of the liver and intestinal fat tissue had also been seen in the bottom of the right thoracic cavity, probably due to the congenital hernia (Fig. 1b, c). She was diagnosed as having ileus due to Chilaiditi’s syndrome and was treated with decompression therapy by a nasoenteric tube. Four days later, she developed dyspnea and her abdominal pain worsened. Laboratory examination showed elevations in the white blood cell count (10,900/μl), C-reactive protein (19.48 mg/dl), fibrin/fibrinogen degradation products (FDP) (12.1 μg/ml), aspartate aminotransferase (AST) (43 U/l), and alanine aminotransferase (ALT) (43 U/l). Chest-abdominal computed tomography (CT) showed intestinal incarceration in the right thoracic cavity (Fig. 2). With these findings, the patient was diagnosed as having incarceration due to a right Bochdalek hernia and Chilaiditi’s syndrome.Fig. 1

View Article: PubMed Central

ABSTRACT

An extremely rare adult case that underwent surgery for ileus caused by Bochdalek hernia associated with Chilaiditi’s syndrome is presented. A 65-year-old woman complaining of upper abdominal pain presented to our hospital. Abdominal plain radiography showed increased intestinal gas, and computed tomography (CT) showed the transverse colon located above the right lobe of the liver, representing Chilaiditi’s sign. She was diagnosed as having ileus and treated with decompression therapy by a nasoenteric tube. After hospitalization, the patient developed dyspnea, and CT showed intestinal herniation into the right thoracic cavity. She was diagnosed as having strangulated ileus caused by Bochdalek hernia. An emergent laparotomy was performed, and it showed a hole of 5 cm in diameter at the right hemi-diaphragm. The transverse colon was incarcerated through the hole, it was pulled back to the abdominal cavity, and a right hemicolectomy was performed because of necrotic changes. A small part of the liver was also herniated into the right thoracic cavity, and it was returned to the abdominal cavity. The defect in the diaphragm was closed by direct suture. Although the patient developed an abscess in the thoracic cavity postoperatively, she improved with antibiotic therapy and was discharged 2 months after the operation.

No MeSH data available.


Related in: MedlinePlus