Symptomless massive herniation: Giant adult bochdalek hernia+

Abstract

Abstract:Eri kin tipi diyafram hernileri sıklıkla travmatik olup delici kesici alet yaralanmalarından sonra görülmektedir. Ancak çok nadir de olsa diyafragmatik konjenital defektlerden ileri ya larda herniasyon olabilir. 34 ya ında erkek hasta kontrol akci er grafisinde patoloji saptanması üzerine hastanemize ba vurdu. Hastanın fizik muayenesinde sol alt zonda solunum seslerinde azalma dı ında pozitif bulgu tespit edilmedi. Hastanın akci er grafisi, toraks tomografisi ve baryumlu tetkikleri sonucunda sol hemitoraksın 2/3 alt kısmını mide ve sol kolon haricinde tüm intestinal sistemin doldurdu u görüldü. Mediastinal shift geli memi ti. Batın solid organları herniye olmamı tı. Sol posterolateral torakotomi yapıldı. Diyafragmanın posterolateralinde 8 cm uzunlu unda defekt ve buradan visserlerin herniye oldu u görüldü. Peritoneal herni kesesi yoktu. Visserler batına ancak median laparotomi yapılarak redükte edilebildi. Postoperatif dönemde komplikasyon geli medi. ım torakotomi olmasına kar ın, masif organ herniasyonunda; organ Kronik tip diyafragma hernilerinde ilk yakla redüksiyonunda batının küçük olması nedeni ile ya anan zorluk ve malrotasyon varlı ı operasyona laparotomi eklenmesini gerektirir.

Abstract:Adult type diaphragm hernias are seen usually in penetrating injuries. But herniation may be possible through the congenital diaphragmatic defects in the adults which rarely occur. A 34-year-old male patient was admitted to the hospital because of the pathologic appearance in his control chest radiography. In his physical examination there was no abnormal finding except decreased breath sounds in the lower part of left hemithorax. It was detected that two-thirds of the left hemithorax was filled with the intestine except stomach and left colon in chest x-ray, CT and graphies with barium. There was no mediastinal shift. Abdominal solid viscera were not herniated. Posterolateral thoracotomy was performed. It was detected that there was a 8 cm-diaphragmatic defect in the posterolateral portion of the diaphragm and intestinal viscera was herniated through the defect to the thorax. There was no peritoneal sac. We could hardly manage the reduction of viscera to the abdomen only after median laparatomy was performed. No complication was determined. Although, thoracotomy is the initial approach for the chronic diaphragmatic hernia, laparotomy should be added to the procedure because of the difficulties in reduction of massive viscera herniation to the small abdomen and presence of malrotation.