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

Watanabe M, Ishibashi O, Watanabe M, Kondo T, Ohkohchi N - Surg Case Rep (2015)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8558, Japan. motowide@aol.com.

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

a Intraoperative photographs showing a hole of 5 cm in diameter at the right hemi-diaphragm. b The part of the transverse colon that was pulled back into the abdominal cavity from the right thoracic cavity. c A part of the right lobe of the liver that was returned to the abdominal cavity from the thoracic cavity (arrow). This part of the liver adhered to the bottom lobe of the right lung. It was separated from the lung and returned to the abdominal cavity
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Fig3: a Intraoperative photographs showing a hole of 5 cm in diameter at the right hemi-diaphragm. b The part of the transverse colon that was pulled back into the abdominal cavity from the right thoracic cavity. c A part of the right lobe of the liver that was returned to the abdominal cavity from the thoracic cavity (arrow). This part of the liver adhered to the bottom lobe of the right lung. It was separated from the lung and returned to the abdominal cavity

Mentions: Exploratory laparotomy was performed, and it showed a hole of 5 cm in diameter at the right hemi-diaphragm (Fig. 3a). The transverse colon was herniated into the right thoracic cavity through the hole. A small part of the right lobe of the liver was also herniated into the cavity and adhered to the bottom lobe of the right lung. The transverse colon was pulled back into the abdominal cavity, but a right hemicolectomy was performed because the incarcerated part had developed necrosis and showed micro perforation (Fig. 3b). The herniated part of the liver was separated from the lung and returned to the abdominal cavity (Fig. 3c). The diaphragmatic defect was closed by direct suture with 1–0 absorbable thread, and drains were placed into the right thoracic cavity and right subphrenic space. The patient developed an abscess in the right thoracic cavity after removal of the chest drain postoperatively (Fig. 4a), and she was treated with systemic antibiotics. The abscess resolved with treatments (Fig. 4b), and she was discharged 2 months after the operation. As of 56 months after the surgery, she is doing well without recurrence of any symptoms.Fig. 3


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

Watanabe M, Ishibashi O, Watanabe M, Kondo T, Ohkohchi N - Surg Case Rep (2015)

a Intraoperative photographs showing a hole of 5 cm in diameter at the right hemi-diaphragm. b The part of the transverse colon that was pulled back into the abdominal cavity from the right thoracic cavity. c A part of the right lobe of the liver that was returned to the abdominal cavity from the thoracic cavity (arrow). This part of the liver adhered to the bottom lobe of the right lung. It was separated from the lung and returned to the abdominal cavity
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig3: a Intraoperative photographs showing a hole of 5 cm in diameter at the right hemi-diaphragm. b The part of the transverse colon that was pulled back into the abdominal cavity from the right thoracic cavity. c A part of the right lobe of the liver that was returned to the abdominal cavity from the thoracic cavity (arrow). This part of the liver adhered to the bottom lobe of the right lung. It was separated from the lung and returned to the abdominal cavity
Mentions: Exploratory laparotomy was performed, and it showed a hole of 5 cm in diameter at the right hemi-diaphragm (Fig. 3a). The transverse colon was herniated into the right thoracic cavity through the hole. A small part of the right lobe of the liver was also herniated into the cavity and adhered to the bottom lobe of the right lung. The transverse colon was pulled back into the abdominal cavity, but a right hemicolectomy was performed because the incarcerated part had developed necrosis and showed micro perforation (Fig. 3b). The herniated part of the liver was separated from the lung and returned to the abdominal cavity (Fig. 3c). The diaphragmatic defect was closed by direct suture with 1–0 absorbable thread, and drains were placed into the right thoracic cavity and right subphrenic space. The patient developed an abscess in the right thoracic cavity after removal of the chest drain postoperatively (Fig. 4a), and she was treated with systemic antibiotics. The abscess resolved with treatments (Fig. 4b), and she was discharged 2 months after the operation. As of 56 months after the surgery, she is doing well without recurrence of any symptoms.Fig. 3

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8558, Japan. motowide@aol.com.

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